Sandra McKay - Academia.edu (original) (raw)

Papers by Sandra McKay

HealthcarePapers

Integrated healthcare models are being experimented with in many jurisdictions as a way to improv... more Integrated healthcare models are being experimented with in many jurisdictions as a way to improve patient care and lower system costs. This commentary presents early lessons from one Ontario Health Team as it works towards new models of care. The authors recount early discussions on developing an integrated health services network, how funding for "winter surge initiatives" became an opportunity to test ideas and how these experiences are informing current planning. Some of the early lessons learned include the value of trusted relationships, moving care upstream and framing problems as collective challenges.

Canadian Journal of Nursing Leadership, 2022

Pediatric nursing expertise in home care requires continuous development and maintenance of compe... more Pediatric nursing expertise in home care requires continuous development and maintenance of competencies. Through the pandemic, practice of essential "hands-on" skills was enabled by delivery of training mannequins from hospital to home care and a shift to virtual education. Learners (n = 57) included family caregivers of children with medical complexity and nurses new to home care. Evaluation informed iterative design of the service and signalled "Connected Care on the Go!" as desirable (100% highly satisfied), feasible (100% easily implemented) and viable. Now a sustainable service, this nurse-led innovation promotes partnership across leaders, sectors and geographies to address specialized training needs in pediatric home care.

Background Overview and Rationale: We co-developed a multi-component virtual care solution (TtLIV... more Background Overview and Rationale: We co-developed a multi-component virtual care solution (TtLIVE) for the home mechanical ventilation (HMV) population using the aTouchAway™ platform (Aetonix). The TtLIVE intervention includes: 1) virtual home visits; 2) customizable care plans; 3) clinical workflows that incorporate reminders, completion of symptom profiles and tele-monitoring; and 4) digitally secure communication via messaging, audio, and video calls;5) Resource library including print and audiovisual material. Objectives and Brief Methods: Our primary objective is to evaluate the TtLIVE intervention compared to a usual care control group using an eight centre, pragmatic, parallel group single blind (outcome assessors) randomized controlled trial. Eligible patients are children and adults newly transitioning to HMV in Ontario, Canada. Our target sample size is 440 participants (220 each arm). Our co-primary outcomes are number of Emergency Department (ED) visits in the 12 months...

Objective: To evaluate the immediate and sustained knowledge retention and sense of self-efficacy... more Objective: To evaluate the immediate and sustained knowledge retention and sense of self-efficacy of homecare nurses following completion of a standardized competency-based tracheostomy education course. Safe discharge of children requiring tracheostomy with or without ventilation relies on the competence of homecare nurses. Study Design: Pragmatic, randomized controlled trial of 44 homecare nurses. Participants were randomized into the intervention group (n=21), which received the tracheostomy course, or the control group (n=23), which received an enterostomy and vascular access course. Multiple-choice question (MCQ) knowledge assessments and self-efficacy questionnaires were administered to both groups pre-course and post-course at 6 week, 3 month, 6 month, and 12 month follow-ups. Results: Twenty participants in the intervention group and 19 in the control group were included. Four withdrew from the study and two crossed over from the control into the intervention arm. The change...

Patient Experience Journal, 2020

International Journal of Integrated Care, 2020

BMJ Open, 2019

IntroductionMany hospitalised older adults experience delayed discharges due to increased postacu... more IntroductionMany hospitalised older adults experience delayed discharges due to increased postacute health and social support needs. Transitional care programmes (TCPs) provide short-term care to these patients to prepare them for transfer to nursing homes or back to the community with supports. There are knowledge gaps related to the development, implementation and evaluation of TCPs. The aims of this scoping review (ScR) are to identify the characteristics of older patients served by TCPs; criteria for transfer, components and services provided by TCPs; and outcomes used to evaluate TCPs.Methods and analysisThe study involves six-step ScR and is informed by a collaborative/participatory approach whereby stakeholders engage in the development of the research questions, identification of literature, data abstraction and synthesis; and participation in consultation workshop. The search for scientific literature will be done in the Medline, PsychINFO, Emcare and CINAHL databases; as w...

Home health care services quarterly

This study evaluated paraprofessional-led diabetes self-management coaching (DSMC) among 94 clien... more This study evaluated paraprofessional-led diabetes self-management coaching (DSMC) among 94 clients with type 2 diabetes recruited from a Community Care Access Centre in Ontario, Canada. Subjects were randomized to standard care or standard care plus coaching. Measures included the Diabetes Self-Efficacy Scale (DSES), Insulin Management Diabetes Self-Efficacy Scale (IMDSES), and Hospital Anxiety and Depression Scale (HADS). Both groups showed improvement in DSES (6.6 + 1.5 vs. 7.2 + 1.5, p < .001) and IMDSES (113.5 + 20.6 vs. 125.7 + 22.3, p < .001); there were no between-groups differences. There were no between-groups differences in anxiety (p > .05 for all) or depression scores (p > .05 for all), or anxiety (p > .05 for all) or depression (p > .05 for all) categories at baseline, postintervention, or follow-up. While all subjects demonstrated significant improvements in self-efficacy measures, there is no evidence to support paraprofessional-led DSMC as an inter...

Journal of Patient Safety, 2016

Background Although attention to patient safety issues in the home care setting is growing, few s... more Background Although attention to patient safety issues in the home care setting is growing, few studies have highlighted health system–level concerns that contribute to patient safety incidents in the home. Found-on-floor (FOF) incidents are a key patient safety issue that is unique to the home care setting and highlights a number of opportunities for system-level improvements to drive enhanced patient safety. Methods We completed a multi-incident analysis of FOF incidents documented in the electronic record system of a home health care agency in Toronto, Canada, for the course of 1 year between January 2012 and February 2013. Results Length of stay (LOS) was identified as the cross-cutting theme, illustrating the following 3 key issues: (1) in the short LOS group, a lack of information continuity led to missed fall risk information by home care professionals; (2) in the medium LOS group, a lack of personal support worker/carer training in fall prevention led to inadequate fall prev...

Physiotherapy Canada, 2014

Purpose: To describe the collaborative goal-setting practices of community-based physical therapi... more Purpose: To describe the collaborative goal-setting practices of community-based physical therapists trained in a self-management (SM) approach who work with clients with chronic conditions and to describe clients' goal-achievement rates. Methods: A retrospective chart review was conducted for 296 randomly selected home-care clients from July 2009 through July 2010 using a chart-abstraction form created to capture demographic data and information related to goal setting and achievement. Data were analyzed using frequencies, percentages, and Pearson's chi-square tests. Results: There was no significant relationship between sex, age, or number of chronic conditions and setting SM or non-self-management (NSM) goals or the type of SM goal set. The majority of goals set were “action” as opposed to “verbal” goals. A high proportion (89–100%) of both SM and NSM goals were met. Conclusions: Clinicians should be aware that it is possible to set SM goals regardless of the client's...

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2012

Experimental Brain Research, 2012

ABSTRACT Accidental falls are the leading cause of death among older adults in the United States.... more ABSTRACT Accidental falls are the leading cause of death among older adults in the United States. One third of all adults aged 65 and older report falling each year. Elders living in institutions have 3 times the chance of falling compared to those living in their homes. Accidental falls are also very common in children of all ages. Young children learning to walk and toddlers are at greater risk of accidental falls resulting in possible cranio-cerebral injury. Practical implications for fall-prevention programs such as balance-training programs or mobility aids to reduce restrictions on lateral stepping movements can reduce accidental falls. This new book presents research findings on the causes, preventions and interventions that impact fall risk.

BMC Geriatrics, 2021

Background Many hospitalized older adults cannot be discharged because they lack the health and s... more Background Many hospitalized older adults cannot be discharged because they lack the health and social support to meet their post-acute care needs. Transitional care programs (TCPs) are designed to provide short-term and low-intensity restorative care to these older adults experiencing or at risk for delayed discharge. However, little is known about the contextual factors (i.e., patient, staff and environmental characteristics) that may influence the implementation and outcomes of TCPs. This scoping review aims to answer: 1) What are socio-demographic and/or clinical characteristics of older patients served by TCPs?; 2) What are the core components provided by TCPs?; and 3) What patient, caregiver, and health system outcomes have been investigated and what changes in these outcomes have been reported for TCPs? Methods The six-step scoping review framework and PRISMA-ScR checklist were followed. Studies were included if they presented models of TCPs and evaluated them in community-dw...

Gerontechnology : international journal on the fundamental aspects of technology to serve the ageing society

Age-related difficulty in controlling lateral stability is of crucial importance because lateral ... more Age-related difficulty in controlling lateral stability is of crucial importance because lateral falls increase risk of debilitating hip-fracture injury. This study examined whether a small increase in footwear sole width can improve ability of older adults to regain lateral stability subsequent to balance perturbation. The study involved sixteen healthy, ambulatory, community-dwelling older adults (aged 65-78). Widened base-of-support (WBOS) footwear was simulated by affixing polystyrene-foam blocks (20mm wide) on the medial and lateral sides of rubber overshoes; unaltered overshoes were worn in normal (NBOS) trials. Balance perturbations were applied using a motion platform. Gait, mobility and agility tests revealed no adverse effects of wearing the WBOS footwear. Lateral-perturbation tests showed that the WBOS footwear improved ability to stabilize the body without stepping (p=0.002). Depending on the perturbation magnitude, the frequency of stepping was reduced by up to 25% (64%...

Journal of interprofessional care, 2016

Home-based palliative care is increasingly dependent on interprofessional teams to deliver collab... more Home-based palliative care is increasingly dependent on interprofessional teams to deliver collaborative care that more adequately meets the needs of clients and families. The purpose of this pilot evaluation was to qualitatively explore the views of an interprofessional group of home care providers (occupational therapists, nurses, personal support work supervisors, community care coordinators, and a team coordinator) regarding a pilot project encouraging teamwork in interprofessional palliative home care services. We used qualitative methods, informed by an interprofessional conceptual framework, to analyse participants' accounts and provide recommendations regarding strategies for interprofessional team building in palliative home health care. Findings suggest that encouraging practitioners to share past experiences and foster common goals for palliative care are important elements of team building in interprofessional palliative care. Also, establishing a team leader who emp...