Dr. Katherine S. McGilton (RN, PhD, FCAHS) is an applied researcher, a Senior Scientist at the Toronto Rehabilitation Institute-University Health Network and a Professor at the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto. She has research funding as the principal investigator from the Canadian Institutes of Health Research (CIHR), Alzheimer Society of Canada, and the MOH<C. She was recently inducted into the Canadian Academy of Health Sciences for her work in the field of aging. The results of her program of research have led to innovations in models of care and positive outcomes on older adults and staff in long term care and rehabilitation environments that have been translated to protocols that guide the provision of care in these settings.
Nurse practitioners and their role in supporting clinical care in Canadian long-term care homes during the COVID-19 pandemic
Katherine S. McGilton, University Health Network, Canada
Shirin Vellani, University Health Network, Canada
Alexandra Krassikova, University Health Network, Canada
Astrid Escrig-Pinol, University Health Network, Canada
Veronique Boscart, University Health Network, Canada
Claudia Mariano, Nurse Practitioners Association of Ontario, Canada
Michelle Acorn, The International Council of Nurses, Switzerland
Background and Objectives
Many older adults residing in Long-Term Care homes (LTCH) are frail and several are at the end-of-life, which makes them increasingly vulnerable to sustaining poor outcomes in crisis situations. During the COVID-19 pandemic in Canada, the largest percentage of deaths were reported among residents in LTCHs. Measures undertaken to limit the spread of the COVID-19 virus such as limiting access to families, and clinical care providers including physicians, inadvertently placed residents at risk of experiencing social isolation and poor outcomes.
The pandemic also made chronic disease management and facilitation of a dignified death experience for residents challenging. The COVID-19 pandemic magnified the challenges faced by staff to deliver high-quality care to residents. Nurse Practitioners (NPs), who are highly skilled clinicians with the ability to independently diagnose and treat residents, were able to support the in-person care to residents in close collaboration with LTCH staff, leaders and external partners including emergency department physicians and other specialists. This study aimed to examine NPs’ roles in optimizing resident care and supporting LTCH staff during the COVID-19 pandemic in Canada.
Research Design and Methods
This exploratory qualitative study employed a phenomenological approach. A purposive sample of 14 NPs working in LTCHs in Ontario, Canada, that reported COVID-19 positive cases, was recruited. Data were generated using semi-structured interviews and examined using thematic analysis.
Three categories were derived regarding NPs’ roles: a) serving as a link between LTCH teams and external partners for care; b) instituting creative care strategies to mitigate the effects of residents social isolation; c) facilitating advance care planning and goals of care discussions for optimal end-of-life care.
Discussion and Implications
COVID-19 pandemic has not only presented the LTCH sector with innumerable challenges but further accentuated chronic deficiencies in health human resources and the effects of inaction that require urgent attention. The residents have increasingly complex care needs yet the workforce required to provide high-quality care is below par. The results of this study demonstrated that NPs supported residents and staff. In many situations, NPs provided essential care in the home, while many physicians shifted to virtual care. They served as a link between LTCH teams and external partners to enhance the care delivered to residents. NPs worked to minimize social isolation and loneliness among residents along with the LTCH team. In collaboration with staff within the home, NPs played a vital role in providing optimal end-of-life care and a dignified death experience for residents and their care partners while navigating the challenges of the pandemic.
The pandemic served as a clear indication that, through their expanded scope and commitment to collaborative practice, NPs are well-positioned to provide timely and evidence-informed care to residents. Moving forward, innovative models of care that include NPs in LTCHs are required. The results of this study have several implications for the role of NPs in LTCHs globally.