Search

Healthcare providers caring for people living with dementia may experience moral distress when faced with ethically challenging situations, such as the inability to provide care that is consistent with their values. The COVID-19 pandemic produced conditions in long-term care homes (hereafter referred to as ‘care homes’) that could potentially contribute to moral distress. We conducted an online survey to examine changes in moral distress during the pandemic, its contributing factors and correlates, and its impact on the well-being of care home staff. Survey participants (n = 227) working in care homes across Ontario, Canada were recruited through provincial care home organizations. Using a Bayesian approach, we examined the association between moral distress and staff demographics and roles, and characteristics of the long-term care home. We performed a qualitative analysis of the survey’s free-text responses. More than 80% of care home healthcare providers working with people with dementia reported an increase in moral distress since the start of the pandemic. There was no difference in the severity of distress by age, sex, role, or years of experience. The most common factors associated with moral distress were lack of activities and family visits, insufficient staffing and high turnover, and having to follow policies and procedures that were perceived to harm residents with dementia. At least two-thirds of respondents reported feelings of physical exhaustion, sadness/anxiety, frustration, powerlessness, and guilt due to the moral distress experienced during the pandemic. Respondents working in not-for-profit or municipal homes reported less sadness/anxiety and feelings of not wanting to go to work than those in for-profit homes. Front-line staff were more likely to report not wanting to work than those in management or administrative positions. Overall, we found that increases in moral distress during the pandemic negatively affected the well-being of healthcare providers in care homes, with preliminary evidence suggesting that individual and systemic factors may intensify the negative effect.

Long-term care (LTC) residents have been disproportionately impacted by the COVID-19 pandemic, both from the virus itself and the restrictions in effect for infection prevention and control. Many barriers exist in LTC to prevent the effective isolation of suspect or confirmed COVID-19 cases. Furthermore, these measures have a severe impact on the well-being of LTC residents. Our aim was to develop a guide for long-term care to address the ethical challenges associated with isolating dementia patients during the pandemic. The Dementia Isolation Toolkit (DIT) was developed by members of the research team in partnership with LTC stakeholders to address: 1) the practical challenges of isolating or quarantining people with dementia in a compassionate, safe, and effective manner; and 2) the need for ethical guidance to support decision-making regarding isolation and infection control in LTC, to prevent indecision and moral distress. To develop the DIT the team reviewed and synthesized the literature on pandemic ethics in a plain-language document, which was then reviewed by our partners and stakeholders. The final ethical guidance tool includes a discussion of the ethics around infection control measures in a pandemic, an ethical decision-making tool, and a person-centred isolation care planning tool. The ethical guidance tool has been downloaded more than 6500 times since it was published (bit.ly/dementiatoolkit), and has been disseminated internationally. The worksheets are being used during outbreaks to support care and decision-making, as well as proactively, to prepare for outbreaks by developing isolation care plans. There is a need for support for ethical decision-making in the context of a pandemic, particularly in settings such as LTC. Future studies will evaluate the implementation of the tool and its impact in addressing moral distress in health care providers in long-term care.

The structural characteristics of carbon nanotube (CNT) make them new interesting aligning layers for liquid crystals (LCs). These highly elongated nanoparticles have surface on which LC strongly anchor and with the use of CNTs sheets, continuous films of aligned CNTs can be easily obtained. Despite the fact that CNT sheets are inhomogenous layers since the linear networks of nanotubes cover partially the plane with gaps, of different distance, in the perpendicular direction and that their degree of orientational order can vary locally, with values well below 1, nematic LCs are oriented by the CNTs along their direction of alignment. The alignment of the LC can be clearly affected by the chosen geometry, as studied with symmetric and asymmetric boundary conditions. Certain alignment could be recognized even with only one aligning surface but two are needed for better and more uniform alignment. The orientational order of CNTs was measured by the anisotropic absorption and found being dependent on the processing steps that decrease its value. Higher value of orientational order of the CNTs seem to be relevant for improving the LC alignment even in the case of use of inorganic coatings of CNTs. With simple assemblies, using two substrates or a single one coated even with one CNT sheet, novel LC applications can be realized such as carbon nanotube-based flexible LCDs or pressure sensors.

Background: Non-communicable diseases are also known as chronic diseases. The burdens of non communicable diseases are increasing day by day. Disability and early death are the results, which are turning out to be the biggest concern for health in the world. The purpose of the study was to assess the awareness of non-communicable diseases and their risk factors among adolescents studying in selected high schools at Mangaluru. Methods: A comparative descriptive research design was adopted for this study. The sample was drawn through a simple random sampling technique and the sample consisted of 120 (60 each) urban and rural adolescents. The tool used for the study was a demographic proforma and structured knowledge questionnaire. Conclusion: The mean percentage of the awareness scores among urban adolescents was 60.31% when compared to rural adolescents 43.06%. There was a significant difference in the level of awareness on non-communicable diseases and its risk factors between urban and rural adolescents that is, the calculated t value (t118=25.55) is greater than the table value (t118=1.98) at a 0.05 level of significance. The findings of the study suggest that schools should play an active role and on another side parents need to provide a supportive environment for their children to adopt a healthy lifestyle.

Highlights • What is the primary question addressed by this study? What strategies can used in the nursing home setting to ensure the safe, effective, and compassionate quarantine of dementia patients with symptoms of COVID-19? • What is the main finding of this study? While there is a clear ethical and legal basis for the involuntary confinement of people with dementia, the potential for unintended harm with these interventions is high, and there is little guidance for nursing homes on how to isolate safely, while maintaining the human dignity and personhood of the individual with dementia. To address these gaps, there needs to be an urgent investment in proper staffing, training, and safe equipment in the nursing home sector. • What is the meaning of the finding? Nursing homes that have not yet been impacted by COVID-19 have a narrow window of opportunity to prepare for the isolation of residents with dementia and front-line staff are now looking to their leadership and government bodies to help prepare to take these actions as safely and compassionately as possible, Nursing homes are facing the rapid spread of COVID-19 among residents and staff and are at the centre of the public health emergency due to the COVID-19 pandemic. As policy changes and interventions designed to support nursing homes are put into place, there are barriers to implementing a fundamental, highly effective element of infection control, namely the isolation of suspected or confirmed cases. Many nursing home residents have dementia, associated with impairments in memory, language, insight and judgment that impact their ability to understand and appreciate the necessity of isolation and to voluntarily comply with isolation procedures. While there is a clear ethical and legal basis for the involuntary confinement of people with dementia, the potential for unintended harm with these interventions is high, and there is little guidance for nursing homes on how to isolate safely, while maintaining the human dignity and personhood of the individual with dementia. In this commentary, we discuss strategies for effective, safe and compassionate isolation care planning, and present a case vignette of a person with dementia who is placed in quarantine on a dementia unit.

Objectives:People working in long-term care homes (LTCH) face ethical dilemmas about how to minimize the risk of spread of COVID-19, while also minimizing psychological hardship and other harms of infection control measures on residents. The Dementia Isolation Toolkit (www.dementiaisolationtoolkit.com; DIT) was developed to address the gap in ethical guidance for LTCH on how to safely and effectively isolate people with dementia while supporting the personhood and well-being of residents. In this presentation, we will present the DIT and report on the results of a survey of LTCH staff in Ontario, Canada on their experiences isolating residents in LTCH and the use of the DIT in supporting person-centred isolation care.Methods:A link to an online survey was distributed to LTCH staff through provincial organizations and agencies as well as through social media and the DIT website. Inclusion criteria were LTCH staff working on-site at a LTCH since March 1, 2020, who had direct or indirect experience with the isolation/quarantine of LTCH residents. Results were summarized descriptively.Results:A broad sample of LTCH staff (n=207) participated in the survey, most of whom had experienced an outbreak in their LTCH. Dementia (96%) was the most important barrier to implementation of infection control measures in LTCH, followed by staff distress about the effects of isolation on residents (61%). Important facilitators for isolation included delivery of 1:1 activities in the resident’s room (81%) and designating essential caregivers to provide support (67%), while inadequate staffing levels were reported as a barrier (55%). 65% of respondents indicated some familiarity with the DIT, and of those who had used the toolkit, 62% found it helpful in supporting isolation care, particularly in developing care plans and making and communicating decisions. Of those who had used the DIT, 48% found it fairly or very helpful at reducing their level of distress.Conclusions:Isolation as an infection control and prevention (ICP) measure in LTCH environments can be harmful to residents and create moral distress in staff. ICP guidance and support of LTCH needs to address how to minimize these harms by providing dementia-specific guidance such as in the DIT.

Dissertação de Mestrado Integrado em Arquitetura, com a especialização em Arquitetura apresentada na Faculdade de Arquitetura da Universidade de Lisboa para obtenção do grau de Mestre. Submitted by Pilar Lago (mpilar@fa.utl.pt) on 2018-05-09T13:01:37Z No. of bitstreams: 1 HABITAR_A_MEMÓRIA_KEVIN_LOPES.pdf: 65308291 bytes, checksum: 4667760a26605f66e47226c0c59d436c (MD5) Made available in DSpace on 2018-05-09T13:01:37Z (GMT). No. of bitstreams: 1 HABITAR_A_MEMÓRIA_KEVIN_LOPES.pdf: 65308291 bytes, checksum: 4667760a26605f66e47226c0c59d436c (MD5) Previous issue date: 2017-12-19 N/A

Dissertação de Mestrado Integrado em Arquitetura, com a especialização em Arquitetura apresentada na Faculdade de Arquitetura da Universidade de Lisboa para obtenção do grau de Mestre. N/A

The purpose of this commentary is to present and respond to the gap that currently exists in providing culturally inclusive residential long-term care options for Indigenous peoples in Ontario. After presenting statistics regarding the Indigenous population and long-term care options, we argue that we have an ethical responsibility to offer more culturally inclusive long-term care., L’objectif de ce commentaire est de présenter et de combler les lacunes existant dans l’offre de soins de longue durée en établissement culturellement inclusifs pour les peuples autochtones de l’Ontario. Après avoir présenté des statistiques sur la population autochtone et les options de soins de longue durée, nous soutenons que nous avons la responsabilité éthique d’offrir des options de soins de longue plus inclusifs sur le plan culturel.