At Providence Care Hospital, Geriatric Psychiatrist Dr. Maria Hussain, and Research Assistant Taylor Smith, are focusing efforts to improve family-centered care for clients of Parkside 2, a secure unit serving the needs of individuals with distressing symptoms of dementia. Clients on Parkside 2 are usually at the stage in their disease where a family member has stepped into the role of substitute decision maker for their loved one.

“Many families experience distress when their loved ones are admitted to Parkside 2,” explains Dr. Hussain. “This is usually a function of the severity of their loved one’s symptoms, accumulated caregiver burden from years of caring for a person with dementia, and a transition to a new and unknown place. These families have been dealing with heightened emotions and caregiver burden. So, the question we are asking ourselves is ‘what can we do from our end that can reduce caregiver distress, ease the transition, and instill hope and trust?’”

Dr. Hussain and Taylor have been working together to examine how the current hospital admission process works for clients with dementia and their families, while investigating how they can improve the communication process, particularly during the pre-admission and admission process.

“People come to Providence Care Hospital from a variety of settings,” explains Taylor. “Individuals come to Parkside 2 from home, from an acute care hospital, and from long-term care homes. Depending on what pathway they take, families might have different information. Not having enough information at the starting point is going to increase levels of distress.”

Taylor explains knowing what to expect translates into confidence for both the client and caregiver, which helps improve care outcomes. Once an individual is admitted to the unit, their care plan is individualized and unique to their needs. For this quality improvement project, Dr. Hussain and Taylor will be focusing on improving communication that is universal to all families while making sure strong connections between families and team members are made on the unit from the get-go.

“We know from the research that there have been many successful quality improvement efforts around early information sharing with patients and their families. This includes a good orientation package before an inpatient psychiatric stay, to a pre-surgical phone call with a nurse. Research says this type of information leads to better outcomes. So, in part, it is about having that knowledge at the beginning to give us better outcomes in the end. If families are feeling a high-level of stress [preadmission] it may snowball into high stress during their loved one’s inpatient stay,” explains Taylor.

Dr. Hussain and Taylor have developed an admission package incorporating input from all involved Parkside 2 team members. This provides an orientation to the unit, introduces all key team members (disciplines) and their roles, outlines key contacts (charge nurse, unit manager), and includes information on important educational and community resources.
“There is the person who enters the hospital who needs care, but with them comes their support system who also needs care,” says Dr. Hussain. “These family members and substitute decision makers have been put into a situation where they are mourning the loss of their loved one, while being tasked with making decisions for all aspects of their care.”
This is where Providence Care’s Spiritual Health Practitioners will come in.

“As part of the admission communication, the Spiritual Health Practitioner will connect with families after their loved one’s referral has been accepted, but before they are admitted,” explains Taylor. “We want to share practical information about what will happen on the day of admission, what papers they need to bring and so on, but also to begin developing a therapeutic relationship between the families and a member of their loved one’s care team,” says Taylor.
“When they first come in, there will already be a familiar face, someone they have made a connection with, and we hope that will instill some confidence and ease the transition,” explains Dr. Hussain.

The quality improvement project on Parkside 2 will go through refinements as Dr. Hussain and Taylor examine how anything implemented is working. They also plan to incorporate feedback from current families and Providence Care Experience Partners about the admission process.

“We’re still in the early stages of our project and our materials, like surveys, are being reviewed by Ethics,” explains Taylor. “After they are approved, surveys will be completed by families and substitute decision makers who have recently experienced care on Parkside 2. We are looking at the information they received before and during admission, so things like, did they receive the admission package? Did they read it? Were there issues they experienced? After we amend the admission package, did that change results? If that does not help, maybe there is something else we can do. Quality improvement is an always evolving process.”

Dr. Hussain and Taylor both say they are excited to see what comes out of their quality improvement efforts. They both stress working with individuals living with dementia takes a family-centered, empathetic approach.

“It is a privilege to care for this population and build therapeutic relationships with their families” says Dr. Hussain. “If the patient can’t advocate for themselves, it is imperative that I keep the family and the substitute decision maker well informed. This gives the family agency, keeps them connected and a part of their loved one’s journey, while also allowing them to address their own mourning where they can come to a place of acceptance.”

The Quality Improvement work on Parkside 2 will help shape how the entire organization manages the admission process with patients, clients, residents, and their families at all Providence Care sites. Dr. Hussain and Taylor’s work on Parkside 2 has been happening alongside the work occurring organizationally, led by Patient Relations Specialist Jamie Watson and Clinical Project Lead, Brittany Gungor.

At Providence Care, our dedicated staff and physicians continue to innovate, challenge themselves and ask questions about how improvements can be made for not only the one receiving care but for the entire support system surrounding them. The work happening on Parkside 2 would not be possible without the generous donations made to the University Hospitals Kingston Foundation. For more information on how to get involved in supporting projects like this, visit uhkf.com.