Barriers and facilitators to person-centred infection prevention and control: results of a survey about the Dementia Isolation Toolkit

Andrea Iaboni; Hannah Quirt; Katia Engell; Julia Kirkham; Steven Stewart; Alisa Grigorovich; Pia Kontos; Josephine McMurray; Anne Marie Levy; Kathleen Bingham; Kevin Rodrigues; Arlene Astell; Alastair J. Flint; Colleen Maxwell

doi:10.1186/s12877-022-02759-4

Barriers and facilitators to person-centred infection prevention and control: results of a survey about the Dementia Isolation Toolkit

Andrea Iaboni, Hannah Quirt, Katia Engell, Julia Kirkham, Steven Stewart, Alisa Grigorovich, Pia Kontos, Josephine McMurray, Anne Marie Levy, Kathleen Bingham, Kevin Rodrigues, Arlene Astell, Alastair J. Flint, Colleen Maxwell

Medicine

Résultat de recherche: Article › examen par les pairs

13 Citations (Scopus)

Résumé

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.

Langue d'origine	English
Numéro d'article	74
Journal	BMC Geriatrics
Volume	22
Numéro de publication	1
DOI	https://doi.org/10.1186/s12877-022-02759-4
Statut de publication	Published - déc. 2022

Note bibliographique

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. The remaining authors have no conflicts of interest to report.

Funding Information:
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. Funders had no role in the design, data collection, analysis or preparation of this manuscript for publication.

Funding Information:
Thank you to the Survey Research Centre at the University of Waterloo for the expert administration of the Dementia Isolation Toolkit survey, and to the DIT partner organizations for their feedback on the survey and distributing the link to their members.

Publisher Copyright:
© 2022, The Author(s).

ASJC Scopus Subject Areas

Geriatrics and Gerontology

PubMed: MeSH publication types

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

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10.1186/s12877-022-02759-4

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Iaboni, A., Quirt, H., Engell, K., Kirkham, J., Stewart, S., Grigorovich, A., Kontos, P., McMurray, J., Levy, A. M., Bingham, K., Rodrigues, K., Astell, A., Flint, A. J., & Maxwell, C. (2022). Barriers and facilitators to person-centred infection prevention and control: results of a survey about the Dementia Isolation Toolkit. BMC Geriatrics, 22(1), Article 74. https://doi.org/10.1186/s12877-022-02759-4

Iaboni, A, Quirt, H, Engell, K, Kirkham, J, Stewart, S, Grigorovich, A, Kontos, P, McMurray, J, Levy, AM, Bingham, K, Rodrigues, K, Astell, A, Flint, AJ & Maxwell, C 2022, 'Barriers and facilitators to person-centred infection prevention and control: results of a survey about the Dementia Isolation Toolkit', BMC Geriatrics, vol. 22, n° 1, 74. https://doi.org/10.1186/s12877-022-02759-4

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title = "Barriers and facilitators to person-centred infection prevention and control: results of a survey about the Dementia Isolation Toolkit",

abstract = "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{\textquoteright}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.",

author = "Andrea Iaboni and Hannah Quirt and Katia Engell and Julia Kirkham and Steven Stewart and Alisa Grigorovich and Pia Kontos and Josephine McMurray and Levy, {Anne Marie} and Kathleen Bingham and Kevin Rodrigues and Arlene Astell and Flint, {Alastair J.} and Colleen Maxwell",

note = "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. The remaining authors have no conflicts of interest to report. Funding Information: 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. Funders had no role in the design, data collection, analysis or preparation of this manuscript for publication. Funding Information: Thank you to the Survey Research Centre at the University of Waterloo for the expert administration of the Dementia Isolation Toolkit survey, and to the DIT partner organizations for their feedback on the survey and distributing the link to their members. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

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doi = "10.1186/s12877-022-02759-4",

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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. The remaining authors have no conflicts of interest to report. Funding Information: 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. Funders had no role in the design, data collection, analysis or preparation of this manuscript for publication. Funding Information: Thank you to the Survey Research Centre at the University of Waterloo for the expert administration of the Dementia Isolation Toolkit survey, and to the DIT partner organizations for their feedback on the survey and distributing the link to their members. Publisher Copyright: © 2022, The Author(s).

PY - 2022/12

Y1 - 2022/12

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.

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Barriers and facilitators to person-centred infection prevention and control: results of a survey about the Dementia Isolation Toolkit

Résumé

Note bibliographique

ASJC Scopus Subject Areas

PubMed: MeSH publication types

Accès au document

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