Qualitative Exploration of St.Vincent’s Hospitals, Langara Residential Interdisciplinary Team Admission (“Moving-In”) Process Authors: Staff of St. Vincent’s Hospitals, Langara: Paramjit Kalkat, Occupational Therapist; Kit Chan, Clinical Dietitian; Karima Kurji, Registered Nurse; Vashti Timmermans, Clinical Dietitian (St.Paul’s Hospital), and UBC Mentor: Maura MacPhee, Assistant Professor, Applied Science/Nursing Programs
Introduction The Eden Alternative Philosophy (EAP) is the overarching philosophy of long term care delivery at St. Vincent’s Langara Residence (SVL). The EAP advocates for staff working together to create a “homelike” environment for residents, where they are free from loneliness, helplessness and boredom.
Results Resident/family & staff perceptions of the admission process: THEME
i) Introduction to Staff
“I would say as far as the first day go, if they would pace it out a little bit and they will give us the card where we can find them.” ~ family member
ii) Introduction to Residents
“Make sure they sit with somebody compatible.” ~ staff
(within 24 hours)
Current research is limited with respect to “how” interdisciplinary teams should conduct an EAP-based admission. B. Communication
This research project explored staff, resident and family perceptions of the admission process, how it reflects the EAP, what needs improving, and how Chinese residents perceive the moving in process. II. Settling In
A. Getting to know the Resident
Goals and Objectives
iii) Introduction to Immediate “She is quite comfortable; she’s got a beautiful room.” ~ family member Environment “Personalizing their space with television, pictures.” ~staff i) Style “Sat down and had a meeting. Just a lot more welcoming. Came in the doors, stood at the front desk, she went over some things with me. Wasn’t nice.” ~ family member ii) Content
Family needed a name or who to contact – primary person to take concerns/questions to. ~ family member
i) Building Trust
Resident was very upset – he feel staff were being very disrespectful due to knowing his past history; he felt ignored, put down, treated differently. ~ resident
“Tries to involve them in a lot of activities suited to their needs… There are choices around food which alleviate the helplessness part. Residents can make choices, cultural preferences…” ~ family member “Some of our problems come from families that do not trust us. Creates huge challenges. If they saw the care plan that would build trust…” ~ staff
• Improve the admission process for residents and families. • Determine any cultural differences with respect to Chinese residents.
i) Partnering in Providing Care ii) Acknowledging Loss
• Better align the admission process with EAP.
Research Questions • Do the families and residents perceive the admission process as representative of the EAP? • Does the care delivery team perceive the admission process as representative of the EAP? • Secondary Question: Are there cultural differences in how our different resident populations (e.g. Chinese perceive the admission process?
Methods Qualitative descriptive design: • 4 focus groups with staff. • 10 interviews with residents and/or family members. • Purposive sampling of English and Chinese-speaking residents and families. N = 10 (4 Chinese, 6 English). Analysis: Focus group and resident/family interviews were audio recorded and transcribed. The data was grouped into meaning units; themes and subthemes were identified.
C. Community Building
i) Forming Long Term Relationships
“Just getting used to this place because I just hadn’t been here very long. It was hard the first time I moved here, after I left St. Paul’s to come here, before where I was living. I had two birds, a boy and a girl. I was worried about them too. So I had to give them up. They’re like my children.” ~ resident “I have friends here… Friends are greeting each other and taking care of each other. That sort of stuff.” ~ resident “If they don’t have family… we kind of make sure the resident will have clothing. If they don’t have money, I will be the one to cut their hair.” ~ staff
Chinese resident/family perceptions of the admission process: Value Same Language Staff Cultural Preferences are Important
“The nurse, Rose, she speaks Chinese, she loves talking to him. He likes her, they were joking around sometimes. If there is a Chinese speaking nurse, he won’t lash out.” ~ family member “There’s two TV on the 3rd floor… everybody watching the same station. Since my mum is Chinese, if there’s a Chinese station there, every other night or some night, that would be nice.” ~ family member
Conclusions • Residents/families value the welcoming process and efforts made to help them settle into their new home.
Literature Cited Eden Alternative Philosophy (2009). Our 10 Principles. Retrieved from: http://www.edenalt.com/our-10-principles
• Chinese residents/families value staff who speak their language & choices around cultural preferences. • Future Recommendations: (1) better prepare residents & their families for discharge from acute to long term care. (2) Develop welcoming rituals to receive new residents/families. • Future study: explore differences regarding language & food preferences in order to better cater to residents.
Acknowledgements Thanks to PHC, UBC, and the “Providence Health Care Research Challenge” for providing support and funding to make this research project possible. •
Many thanks to our mentor, Maura MacPhee.