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Background Visiting restrictions were enacted in Aotearoa New Zealand to reduce transmission of COVID- 19 and protect the healthcare system. This research aimed to investigate the experiences of families and clinicians of hospital visiting for people with palliative and end- of- life care needs during restrictions. Methods Semistructured interviews were completed between March and October 2021 with family members and clinicians who had personally experienced enactment of visiting restrictions during pandemic restrictions. A critical realist ontology was used to approach data analysis, sorting and coding to generate themes. Results Twenty- seven participants were interviewed, 13 being families who had experienced bereavement of a family member during the restrictions: seven nurses or physicians and seven being non- bereaved family members. Four themes were generated: patient safety-- (re)defining the 'Visitor'; the primacy of SARS- CoV- 2-- patient safety and negotiating risk; dying alone: enduring harms; and agency, strategies and workarounds. Conclusion Visitor rights and visitor policy at the end of life require greater protection during a pandemic. Transparent, coherent, publicly available evidence- based guidelines that key stakeholders, including patients, families and ethicists, are included in producing, are urgently required. We want to avert a legacy of disenfranchised grief in future pandemics. [ABSTRACT FROM AUTHOR]

Background: Older people with frailty and multimorbidity are at high risk of problematic polypharmacy. Community pharmacists have a key role in medication safety for older people. Aim: The aim of this study was to investigate the perspectives of older people with frailty, multimorbidity, and polypharmacy, and their family caregivers or whānau on the role of community pharmacists, including in situ pharmacist care practices. Method: This study was part of a larger video reflexive ethnography (VRE) study to explore medication safety and wellbeing for older people with frailty across care transitions including hospital, home, aged residential care, primary care, and outpatient care. This paper reports data from the interview, participant observation, and filming phases of the study. Results: Community pharmacists play a significant role in the medication safety of older people with frailty and polypharmacy. Analysis resulted in three main themes: (1) the older person–determined role of the pharmacist, (2) the 'taken for granted' safety work of the pharmacist, and (3) collective agency and medication safety. Conclusion: In circumstances where older people and their family caregivers or whānau had a trusted relationship with a community pharmacist, the pharmacist played a key role as mediator of medication safety and was central to older people's care. This key role as a member of the multidisciplinary team in the care of older people with frailty and multimorbidity should be better recognised and legitimised by clinicians and policy makers and resourced accordingly. [ABSTRACT FROM AUTHOR]

Cognitive stimulation therapy (CST) is an evidence-based group intervention for people with dementia. In response to the COVID-19 pandemic, many existing CST groups moved virtually and this required carers of people living with dementia to assist with setting up the appropriate technology. This study aimed to explore the roles and experiences of carers in accessing virtual CST (vCST). This qualitative study used semi-structured individual interviews, via telephone or videoconference, to explore the roles and experiences of carers. Interviews were recorded, transcribed verbatim and thematically analysed. Twelve family carers (age: 51–75 years) reported a range of experiences, from novice to expert knowledge in terms of accessing digital devices (mainly laptops and iPads) and connecting to Zoom. Accessing vCST provided carers an immediate application of new knowledge. Carers reported positive responses to vCST that provided their family member living with dementia with social contact and cognitive stimulation during lockdown. Accessing vCST required carers to have an existing adequate level of technological competence in order to learn and use the Zoom platform. Adult learning principles can be used to improve carers' digital literacy required for vCST and other telehealth initiatives. [ABSTRACT FROM AUTHOR]

Semi-structured interviews were conducted to explore the constituents of spirituality for six residential aged care residents and six bereaved family members. Transcripts were analysed thematically and mapped to Lartey's integrated dimensions of spirituality. Findings suggest that spirituality is best described through the lens of connection, whether with the transcendent (religious belief), in oneself (identity), with another (family support), with a group (religion), or with space (RAC descriptor). The findings of this study highlight the importance of creating a balance between biomedical and spiritual aspects of care in RAC especially for culturally diverse residents and families. [ABSTRACT FROM AUTHOR]

Objective Setting Participants Design Results Conclusion Rural unpaid caregivers experience different opportunities and challenges than their urban counterparts. Our aim was to understand rural unpaid caregivers' experiences of challenges and opportunities during the Covid‐19 pandemic in New Zealand.Rural northern New Zealand during the Covid‐19 pandemic.A convenience sample of 10 unpaid rural caregivers, most supporting an older person living with dementia.A qualitative descriptive design. Data included interviews and online workshops, and a thematic analysis.Rural unpaid caregivers observed that some aspects of living in a rural context were helpful during the Covid‐19 pandemic. However, tasks such as shopping and long‐distance travel and communication (both telephonic and digital) became more complex. Abrupt changes to routine and closure of resources and support groups created challenges. Unpaid caregivers worried about what would happen if they were hospitalised themselves. There was a diversity of experience both across caregivers, of familiar routines and rural context as resources, increased challenges requiring resourcefulness to adapt, and experiences of crisis. Many experienced all three states at different times.This research provides valuable insights into challenges and opportunities experienced by rural unpaid caregivers during the Covid‐19 pandemic and may help policy‐makers and healthcare professionals develop improved emergency preparedness. Multilevel, multisector responses are needed to ensure effective health and social support and access to resources including health care, access to groceries and medication, transport, and communications (telephone and digital). Enhancing rural access to effective and inexpensive online services is particularly important, as is recognition of the value of rural sites or hubs of connection and social interaction. [ABSTRACT FROM AUTHOR]

Background: Research has indicated that clinical staff in long‐term care often lack self‐confidence in palliative care delivery, particularly at the end of life. Goals: (a) To examine the contribution of age, palliative care education, palliative care work‐related experience and psychological empowerment to palliative care delivery confidence and (b) to explore the social reality shaping those factors for long‐term care staff. Design: Explanatory sequential design. Setting: Twenty long‐term care facilities in two district health boards in New Zealand. Participants: Phase 1:139 clinical staff. Phase 2:46 clinical staff who provided care in the last month of a residents' life. Methods: Phase 1: Cross‐sectional survey. Phase 2: Individual semi‐structured interviews. Results: Phase 1: Previous experience (β =.319) and psychological empowerment (β =.311) contribute most to predicting an increase in palliative care delivery confidence. Phase 2: Four factors underlay palliative care delivery confidence, (a) mentorship by hospice nurses or colleagues (b) contextual factors (organisational culture, resources and experience), (c) maturity and (d) formal education. Conclusion: Organisational leadership should use multiple strategies (e.g. power‐sharing, increased opportunities for mentorship) to improve staff palliative care delivery confidence. Implications for Practice: This study adds to the literature in understanding the predictors of palliative care delivery confidence specific to long‐term care staff. The results indicate that educational interventions must be contextually appropriate to achieve sustainable improvements in palliative care confidence and ultimately in resident care at the end of life. [ABSTRACT FROM AUTHOR]

In industrialised countries, a large number of older adults with increasingly complex end of life care needs will die while in long-term care. It is essential that processes be in place to facilitate quality end of life care in these settings. In collaboration with two local hospices over the course of one year, we developed a new model of palliative care within long-term care – Supportive Hospice Aged Residential Exchange (SHARE). SHARE fostered knowledge exchange between hospice nurses and long-term care staff to improve palliative care delivery within 20 long-term care facilities (LTCF's). An in-depth qualitative investigation of the views of 59 healthcare professionals and 12 bereaved family members of residents, regarding SHARE implementation, was undertaken through semi-structured interviews. Transcripts were analysed thematically and mapped to the theoretical domains framework (TDF) in order to identify facilitators and challenges to SHARE implementation. Domains facilitating SHARE implementation provided benefits in terms of 'knowledge', 'skills development', and supported the mentoring and role modelling provided by the hospice. Challenges highlighted the resource constraints of the long-term care context. The use of the TDF has enabled the identification of essential components such as skills development, which facilitate the implementation of SHARE in LTCF's. [ABSTRACT FROM AUTHOR]

Objectives: The growing demand for palliative care has been accelerated due to the COVID-19 pandemic. However, providing community-based palliative care was also more difficult to do safely and faced several challenges. The goal of this integrative review was to identify, describe, and synthesize previous studies on the challenges for health professionals delivering palliative care in the community during the COVID-19 pandemic., Methods: Searches were carried out on the Ovid MEDLINE, CINAHL, PsycINFO, Social Care Online, PubMed, Embase, and Expanded Academic databases. Journals typically reporting palliative care and community health studies were also searched ( Palliative Medicine, Journal of Pain and Symptom Management , and Health & Social Care in the Community ). All articles were peer-reviewed and published in English between December 2019 and September 2022., Results: Database and hand searches identified 1231 articles. After duplicates were removed and the exclusion criteria applied, 27 articles were included in the final review. Themes in the research findings centered on 6 interconnected categories. The challenges imposed by the pandemic (lack of resources, communication difficulties, access to education and training, and interprofessional coordination), as well as the varying levels of success of the health-care responses, impacted the well-being of health professionals and, in turn, the well-being and care of patients and families., Significance of Results: The pandemic has provided the impetus for rethinking flexible and innovative approaches to overcome the challenges of delivering community palliative care. However, existing governmental and organizational policies require revision to improve communication and effective interprofessional collaboration, and additional resources are needed. A blended model of virtual and in-person palliative care delivery may provide the best solution to community palliative care delivery moving forward.