TY - JOUR
T1 - Barriers and facilitators to person-centred infection prevention and control
T2 - results of a survey about the Dementia Isolation Toolkit
AU - Iaboni, Andrea
AU - Quirt, Hannah
AU - Engell, Katia
AU - Kirkham, Julia
AU - Stewart, Steven
AU - Grigorovich, Alisa
AU - Kontos, Pia
AU - McMurray, Josephine
AU - Levy, Anne Marie
AU - Bingham, Kathleen
AU - Rodrigues, Kevin
AU - Astell, Arlene
AU - Flint, Alastair J.
AU - Maxwell, Colleen
N1 - Funding Information: The author A.J. Flint discloses grant support from the U.S. National Institutes of Health, Patient-Centered Outcomes Research Institute, Canadian Institutes of Health Research, Brain Canada, Ontario Brain Institute, AGE-WELL, and the Canadian Foundation for Healthcare Improvement. This study was supported by funds from the Province of Ontario Rapid Access COVID-19 research grant; the Walter and Maria Schroeder Institute for Brain Innovation and Recovery; an Academic Scholars Award from the Department of Psychiatry, University of Toronto (AI); and the Neuropsychiatric Symptoms team (Team 11) of the Canadian Consortium on Neurodegeneration in Aging, which is supported by a grant from the Canadian Institutes of Health Research with funding from several partners.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Background: People working in long-term care homes (LTCH) face difficult decisions balancing the risk of infection spread with the hardship imposed on residents by infection control and prevention (ICP) measures. The Dementia Isolation Toolkit (DIT) was developed to address the gap in ethical guidance on how to safely and effectively isolate people living with dementia while supporting their personhood. In this observational study, we report the results of a survey of LTCH staff on barriers and facilitators regarding isolating residents, and the impact of the DIT on staff moral distress. Methods: We completed an online cross-sectional survey. Participants (n = 207) were staff working on-site in LTCH in Ontario, Canada since March 1, 2020, with direct or indirect experience with the isolation of residents. LTCH staff were recruited through provincial LTCH organizations, social media, and the DIT website. Survey results were summarized, and three groups compared, those: (1) unfamiliar with, (2) familiar with, and (3) users of the DIT. Results: 61% of respondents identified distress of LTCH staff about the harmful effects of isolation on residents as a major barrier to effective isolation. Facilitators for isolation included delivery of 1:1 activity in the resident’s room (81%) and designating essential caregivers to provide support (67%). Almost all respondents (84%) reported an increase in moral distress. DIT users were less likely to report an impact of moral distress on job satisfaction (odds ratio (OR) 0.41, 95% CI 0.19-0.87) with 48% of users reporting the DIT was helpful in reducing their level of moral distress. Conclusions: Isolation as an ICP measure in LTCH environments creates moral distress among staff which is a barrier to its effectiveness. ICP guidance to LTCH would be strengthened by the inclusion of a dementia-specific ethical framework that addresses how to minimize the harms of isolation on both residents and staff.
AB - Background: People working in long-term care homes (LTCH) face difficult decisions balancing the risk of infection spread with the hardship imposed on residents by infection control and prevention (ICP) measures. The Dementia Isolation Toolkit (DIT) was developed to address the gap in ethical guidance on how to safely and effectively isolate people living with dementia while supporting their personhood. In this observational study, we report the results of a survey of LTCH staff on barriers and facilitators regarding isolating residents, and the impact of the DIT on staff moral distress. Methods: We completed an online cross-sectional survey. Participants (n = 207) were staff working on-site in LTCH in Ontario, Canada since March 1, 2020, with direct or indirect experience with the isolation of residents. LTCH staff were recruited through provincial LTCH organizations, social media, and the DIT website. Survey results were summarized, and three groups compared, those: (1) unfamiliar with, (2) familiar with, and (3) users of the DIT. Results: 61% of respondents identified distress of LTCH staff about the harmful effects of isolation on residents as a major barrier to effective isolation. Facilitators for isolation included delivery of 1:1 activity in the resident’s room (81%) and designating essential caregivers to provide support (67%). Almost all respondents (84%) reported an increase in moral distress. DIT users were less likely to report an impact of moral distress on job satisfaction (odds ratio (OR) 0.41, 95% CI 0.19-0.87) with 48% of users reporting the DIT was helpful in reducing their level of moral distress. Conclusions: Isolation as an ICP measure in LTCH environments creates moral distress among staff which is a barrier to its effectiveness. ICP guidance to LTCH would be strengthened by the inclusion of a dementia-specific ethical framework that addresses how to minimize the harms of isolation on both residents and staff.
UR - http://www.scopus.com/inward/record.url?scp=85123764962&partnerID=8YFLogxK
U2 - 10.1186/s12877-022-02759-4
DO - 10.1186/s12877-022-02759-4
M3 - Article
C2 - 35078424
AN - SCOPUS:85123764962
SN - 1471-2318
VL - 22
JO - BMC Geriatrics
JF - BMC Geriatrics
IS - 1
M1 - 74
ER -