Enhancing relationships, improving care

For elderly people in long-term care, a large part of their world is their nurses. The quality of their relationships with care providers has a huge impact on their quality of life. Dr. Katherine McGilton, a Senior Scientist at Toronto Rehab, is studying ways to make those relationships better.

"I'm interested in learning how to measure and enhance relationships between care providers like health care aides or registered practical nurses and the clients who live there,” says Dr. McGilton.

Her research on staff-patient interactions currently focuses on patients with communication impairments, such as those with dementia or cerebral vascular infarcts. More than 50 per cent of patients in long-term care and complex continuing care have communication impairments that can negatively influence patient-caregiver interaction.

“Evidence suggests that nurses do not have the prerequisite skills to communicate effectively with these vulnerable patients,” says Dr. McGilton. “The patient often becomes agitated and the nurse becomes frustrated―and we believe this undermines the quality of care.”

Dr. McGilton and colleagues have been testing a new approach with stroke patients who may have communication impairment. Key to their new intervention is the involvement of a speech-language pathologist―and the development of a communication strategy tailored to each patient. Individualized plans might include: specific topics the patient likes to discuss; how the patient communicates; and ways to avoid communication breakdown.

Results to date suggest that, as a result of the intervention, nurses’ interactions with patients improve, and some patients are less anxious and agitated.  A controlled investigation is now underway.

The quality of long-term care also depends in part on the unit supervisor. Because supervisors are such an important part of the team, Dr. McGilton is developing ways of enhancing supervisors’ ability to be supportive with staff. In addition, her work focuses on understanding their role, their influence on knowledge translation, and the factors influencing retention of supervisors in long-term care. She is also investigating their impact on the job satisfaction of health care aids and other unregulated staff.

The focus of Dr. McGilton’s most recent research is patients with cognitive impairment, such as delirium and/or dementia, specifically those with hip fractures. With colleagues at Toronto Rehab, she has developed a new model of care for cognitively-impaired fracture patients. The approach shows that patients who receive a creative, sensitive and personally tailored form of rehabilitation can do well. “These patients can be successfully rehabilitated and can have many more years living in their own homes,” says Dr. McGilton.

The model of care is now being implemented and evaluated in two community health care centres.

Dr. McGilton was first attracted to her area of research because she saw an opportunity to have a major impact on patient care. "My work is practical―and it's unique." she says. “It contributes to both gerontology and administration. That is a very unusual combination."  

Recipient of the RNAO Leadership Award in Nursing Research in 2006, Dr. McGilton is a former Career Scientist with the Ministry of Health and Long-Term Care.

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