The opportunity for PSWs to apply Stroke Best Practices in the home - - PowerPoint PPT Presentation

The opportunity for PSWs to apply Stroke Best Practices in the home

OGA Conference May 2, 2013

Bonnie Stegemann, PSW Paul Holyoke, Director of Research & Program Development

What we want to do today

• 1. Highlight a new wave of research on the PSW’s role

in today’s health care system

• 2. Introduce Stroke Best Practice Recommendations
• 3. Show how Best Practice Guidelines can be adapted

to the PSW and her/his role

• 4. Tell about efforts to include PSWs in true

partnerships with other health care workers

• 5. Tell about challenges to advancing personal support

practice

Stroke

• Leading cause of adult disability in Canada
• 3rd leading cause of death
• 50,000 Canadians have a stroke every year
• More expected due to aging and increase in

diabetes and obesity

• 22,000 Ontarians have had a stroke
• Highest incidence: South Central Stroke Region
• 75% of stroke survivors need help with ADLs

• Well developed: emergency and acute care
• Some development for long term care
• Less developed:
• Rehabilitation at home and in the community
• Community reintegration

Canadian Stroke Strategy Best Practice Recommendations 2010

• Examples of recommendations
• Help and training in ADLs
• Management of mobility problems and speaking

problems

• Managing medications, emotions, memory changes
• Referrals to peer support groups and other

community services and resources

• Support for caregivers

Best Practice Recommendations Community Rehab & Reintegration

Destination

• Acute care –

6.3%

• Long term care –

7.0%

• Complex continuing care –

7.3%

• Inpatient rehab –

22.7%

• Home with services –

14.3%

• Home without services –

41.0%

Discharge from acute care

2007-8

Destination

• Acute care –

6.3%

• Long term care –

7.0%

• Complex continuing care –

7.3%

• Inpatient rehab –

22.7%

• Home with services –

14.3%

• Home without services –

41.0%

Discharge from acute care

2007-8

Home with services

2007-8

• OT/PT services for 1/3 to 1/2 of home care clients
• OT/PT visits extremely limited (2-3)
• Clients received 10 times as many PSW visits
• PSWs provide ~70% of all home care services

Our Questions

• 1. What do the Best Practice Recommendations say

about the PSW’s role?

• 2. Are PSWs providing Best Practice care for stroke

survivors?

• 3. Is there a potential for PSWs to provide better or

more support to stroke survivors and their caregivers?

The project

• 1. Funded by Ministry of Health and Long-Term

Care/Ontario Stroke Network

• 2. Research team:
• Dr. Paul Holyoke and Dr. Wendy Gifford
• Melissa Aldoroty, Danielle Bender, Susan Donison,

Vivienne Epstein, Jody Hales, Judy Provencher, Bonnie Stegemann, Justine Toscan, Sandra Tudge

Views expressed not necessarily the Ministry’s or the Ontario Stroke Network’s.

Our questions

• 1. What do the Best Practice Recommendations say

about the PSW’s role?

• 7 members of the research team
• PSW, Supervisor, OT, PT, SLP, 2 researchers

Best Practice Recommendations

• No mention of PSWs
• Mostly focused on regulated health professionals
• Why?
• BPRs are based on evidence
• Evidence is based on research
• Research is oriented to health professionals

Best Practice Recommendations

• Used an international method of adapting best

practice recommendations (www.adapte.org)

• Identified 13 areas of client care in the BPRs – e.g.,
• Activities of Daily Living
• Client and Caregiver Support
• Communication
• Home Safety and Falls Prevention
• Mental Health and Behaviour Change
• Mobility, Positioning and Transfers
• Swallowing Difficulties

Best Practice Recommendations

IDENTIFICATION AND MANAGEMENT OF POST-STROKE DEPRESSION

7.3i. All patients with stroke should be screened for depression using a validated tool [Evidence Level A] (SCORE). Screening should take place at all transition points and whenever clinical presentation indicates. Transition points may include:

• a. upon admission to acute care, particularly if any evidence of

depression or mood change is noted

• b. before discharge to the community from acute care or during early

rehabilitation if transferred to inpatient rehabilitation setting

• c. periodically during inpatient rehabilitation
• d. periodically following discharge to the community

Best Practice Recommendations

IDENTIFICATION AND MANAGEMENT OF POST-STROKE DEPRESSION

7.3iii. Patients with mild depressive symptoms should be managed by “watchful waiting,” with treatment being started

• nly if the depression is persistent [Evidence Level A].

… 7.3x. Patients and their caregivers should have their psychosocial and support needs reviewed on a regular basis as part of long-term stroke management [Evidence Level A].

Best Practice Recommendations

Developed a framework to identify potential PSW role:

• Observe
• Coach
• Assist
• Report

Best Practice Recommendations

Public consultation

• 3 areas of care out for public consultation:

– Mental Health and Behaviour Change – Swallowing Difficulties – Home Safety and Falls Prevention

• Specifically consulting:

– PT, OT, SLP & Nursing Colleges and Associations – Regional stroke networks

Our questions

• 2. Are PSWs providing Best Practice care for stroke

survivors?

• 3. Is there a potential for PSWs to provide better or

more support to stroke survivors and their caregivers?

• Chart reviews (n=234)
• Surveys (n=270)
• Interviews (n=28)
• Context review

Overall Findings

• PSWs have a critical role in communicating client

and caregivers’ personal preferences regarding progress, needs or changes in conditions

• PSWs have an important voice in ensuring client

preferences are unfiltered and central in the development of RHPs’ goals and re-setting of new goals for stroke rehabilitation and community reintegration.

Overall Findings

• A major barrier: lack of awareness of the PSW’s

scope of practice, training and potential contributions.

• Current model of care precludes the PSW from

being an integral and contributing member of the healthcare delivery team

Overall Findings

• There is the potential for PSWs to play an

important role in coaching and assisting clients with regulated health professional rehabilitation and community reintegration plans.

• Further training may be required for PSWs to work

to their full scope of practice in stroke rehabilitation and community reintegration.

Overall Findings

• Different modalities and types of training should

be explored to integrate the PSW as a contributing member of the healthcare team, including inter- professional training involving the PSWs.

Overall Findings

• The extensive time PSWs spend with clients and

caregivers in their homes allows them to reinforce continuity of care

• Mechanisms are needed (i.e. policies, procedures,

and funding) including a new model of care that enables PSWs to communicate more directly with rehabilitation professionals regarding client progress, goals and preferences.

Overall Findings

• Our “Observe, Coach and Assist, Report”

framework to categorize PSW activities could be useful for communicating the role of PSWs in enhancing best practices in stroke rehabilitation and community reintegration.

What do our findings mean

• Potential for PSWs to be more integrated within

interdisciplinary stroke care teams

• Need for PSWs to have access to important client

information related to rehabilitation

• Need for PSWs to have input into team

information about clients

• Need to enhance health professional and public

understanding of the role PSWs can and do play in the provision of evidence-informed care

Questions and comments