As the Covid-19 pandemic continues to ravage long-term care homes, U of T Nursing Professor Kathy McGilton (pictured right), wants to explore what she calls the hidden solution to the ongoing crisis: Nurse Practitioners.
“Since the pandemic struck, we have seen nurse practitioners (NP’s) expand their role in long-term care to provide support to management, staff, residents, and families, as well as offer in-person care, and expertise on infection prevention control,” says McGilton who is also a Scientist at the KITE Research Institute at University Health Network. “NP’s are ideally placed to implement recommendations from researchers to keep long-term care homes Covid-19 resilient.”
McGilton has received grant funding from the Canadian Foundation for Health Improvement (CFHI), the Canadian Institute of Health Sciences (CIHR) and the Canadian Centre for Aging & Brain Health Innovation (CABHI): Implementation Science Teams, to conduct a year-long study to evaluate evidence-based intervention strategies led by nurse practitioners.
The intervention strategies, organized into four categories including clearer direction and communication practices and policies, support for staff, as well as infection control and palliative care guidelines, rely on nurses acting in a position of leadership.
By piloting these interventions, McGilton and her team are hoping to assess their cost and sustainability as well as their influence on better health outcomes for long-term care residents.
“We are also hoping to see an improvement in the working environment for staff,” says McGilton, “especially with a focus on issues like moral distress.”
Part of the groundwork for the development of these intervention strategies stemmed from interviews McGilton conducted with more than a dozen NP’s during the first few months of the pandemic to understand the impact of Covid-19 on LTC homes. McGilton discovered that all of the NP’s interviewed had stepped in to fill large gaps in care management, left by the shift of onsite physicians to virtual care and the ever-changing nature of the virus’ rapid spread.
“What they were doing was remarkable,” McGilton says.
To support homes with Covid-19 outbreaks, NP’s proactively established emergency department avoidance strategies, which McGilton emphasizes, were integral to helping manage health system capacity. Some of these strategies included decision making around decanting, a term used to describe emergency preparedness procedures and the separation of patients who may require more acute care.
Many NP’s also took on the responsibility of educating LTC staff about cohorting protocols to manage infections, while also coaching them in the proper use of personal protective equipment (PPE).
McGilton also found that NP’s were providing direct resident care for acute conditions as well as palliative and end of life care. This included communication with residents and their decision-makers, about a resident’s health status, goals of care and treatment options, as well as coordination of care with physicians and specialists through hospitals or virtual appointments.
Corinne Pollard, one of the NP’s involved in the study, and a graduate of the Master’s program at U of T Nursing, says that she has tried to use her role to provide a cohesive strategy of support and advocacy for both LTC staff and residents.
“When I arrive onsite, I ask the staff which residents they are concerned about, or have they noticed someone’s health deteriorating, and I guide them on next steps so that they will know what to do when I am not there,” says Pollard who has worked in LTC homes experiencing outbreaks in the Sarnia-Lambton region.
“I also provide a level of support and advocacy for staff, especially if they are sick or in isolation. They are burnt out, they have seen people they care about die, so I do what I can to stay connected and reassure them that it is going to be okay,” says Pollard.
A list of 19 recommendations is being reviewed by the long-term care homes participating in the study, and include improvements to communication, such as daily huddles with staff and the use of messaging platforms, keeping residents healthy by helping staff understand when a patient is deteriorating, and providing human connectedness strategies to minimize resident isolation.
Many of these recommendations, McGilton says, could be NP led.
Read the full list of recommendations published in JAMDA
She cautions though that these changes will not be easy to implement.
“These are broad interventions for long-term care homes, and they will be difficult to sustain without dedicated resources, and NPs may be one of the solutions,” says McGilton.
As this first phase of the study gets underway, McGilton is aiming to eventually have these intervention strategies available on a website for NP’s and other staff working in long-term care to have right at their fingertips.
“We have yet to find an effective way to keep SARS-CoV2 out of our LTC homes,” says McGilton, “so it is imperative we support our staff within the homes.”