INsite: What led you to pursue a career and research in the field of aged care?
Veronique Boscart: It all started with two exquisite grandmothers who instilled in me a deep respect for elders and taught me that an older person’s wisdom, interest and enthusiasm can make a difference.
A house filled with people showed me the importance of social relations and kinship in a person’s life.
The seniors’ community offered me my first job at age 15, cleaning windows. Little did I know that the stories of the people living on the other side of the windows would become the most enjoyable part of my career.
By this time I was convinced I wanted to work with seniors. So I became a nurse. I felt that nursing was a profession in which one could respect seniors while addressing their care needs. As a new grad, I applied for a job in a seniors’ home. Little did I know, but
I somehow persuaded the Director of Care to give the job of charge nurse to me. And I loved it.
From then on, opportunities and supporters were endless and at times surprisingly unexpected. I explored different roles and positions of geriatric nursing in a variety of settings and countries, and over time became more and more committed to seniors’ care.
Then came the day I wanted to explore nursing in Canada.
Leaving my home country of Belgium was one of the most interesting things I have done. It was adventurous and exciting, yet most of all it meant adapting to the reality of a seniors’ care environment where education and workforce development was desperately needed.
My nursing career expanded and I went back to school to earn a PhD and subsequent post-doc.
I now hold a CIHR/Schlegel Industrial Research Chair for Colleges in Seniors Care at Conestoga College. A lengthy title, yet it allows me to do what I like best: further developing the substantive area of evidence-informed care in gerontology, curriculum development for health care education, and building relational practices in long-term care.
In the end, it comes back to relating to older people, being committed to strengthening seniors’ care, and building a new generation of care professionals to continue this work. Whenever I provide care, teach or conduct research, I always keep in mind that the person in front of me is someone’s grandmother or grandfather putting their trust in me as a nurse.
INsite: Can you please share a little about your current areas of research?
Veronique: I now hold a CIHR/Schlegel Industrial Research Chair for Colleges in Seniors Care at Conestoga College and I am the Director of the Schlegel Centre for Advancing Seniors Care at the College, located in Kitchener, Ontario, Canada.
The current areas of research that we are mostly involved in focus on enhancing gerontological best practices for nurses and other health care providers in all sectors of the healthcare system, which includes evidence-informed care in gerontology and curriculum development for healthcare education. Most of our work focuses on nurses and unrelated care providers (care aides) in home care and community care, as well as in nursing homes or homes for the aged.
INsite: What will you be sharing with NZACA conference delegates?
Veronique: I am privileged to have the opportunity to present a keynote on a standardized assessment system for seniors used in Canada, called interRAI. I will be discussing the journey Canada has taken to adopt this suite of tools. I will also be discussing how the interRAI tools are utilized in different sects of the healthcare system (home care, long-term care, acute care, etc) and how we utilize information collected to make informed decisions related to daily care planning, quality improvement at an organizational and system level, staffing, funding, and workforce development at a provincial and national level.
INsite: From your experience with interRAI, what do you perceive as the key benefits of the assessment system?
Veronique: interRAI has many benefits. InterRAI assessments can be utilized in all parts of the healthcare continuum. This means that there is potential for a seamless transition for a patient/client/person from one healthcare setting to another, where that person’s previous assessment in that setting can be provided to the next setting. This can reduce the repetition of assessments, which is often a common problem in the current healthcare systems. InterRAI also provides ready to use clinical information for immediate care planning and interventions. As a practitioner, the data collected and provided with interRAI tool inform me of what leave and type of care is needed and where the priority areas are for this specific person.
Another benefit is that interRAI allows for comparison between and across populations, which in turn has potential system-wide quality improvement initiatives and economic benefits.
INsite: And what are the biggest challenges with interRAI?
Veronique: At times, when teaching the use of interRAI tools to healthcare providers and/or decision makers, I hear concerns about “how long” the assessment will take. We do have a tendency in healthcare to stick to ‘What we know’ because “We have always done it this way”. Needless to say that the context of health car has changes drastically: higher number of patients, more complex chronic disease management, shorter length of stay in acute care, limited resources, more transitions between care settings, to name a few.
As a result, we need to think very carefully about who collects what type of information from the patient and how we use this information most efficiently to provide the right care, at the right time, in the right care setting, by the right care provider. interRAI’s suite of instruments support the idea of collecting the needed data to inform the care and support the patient to transition thought the health care system.
Some health care providers like to use their ‘own’ tools and keep this info within their own discipline or care setting. Unfortunately, this does not benefit the patient in the long run, nor is it an appropriate use of the limited health care dollars we have available in our systems. For some health care providers, moving away from ‘my assessment’ to ‘what is needed for the patient over time’ is, at times, a bit of a challenge.
INsite: Are we starting to see global trends emerge from interRAI data? Or is interRAI more useful as a national/localised tool?
Veronique: Currently, we have about 40 countries working with interRAI. Some of these countries have interRAI as a mandatory and integrated system across all their health care settings at a national level. Other countries have made interRAI mandatory across some specific settings (home and community care for example. More and more countries are recognizing that an integrated approach to data collection is part of a standard of practice.
INsite: From what you know of the New Zealand aged care system, do you think we face similar challenges to those of Canada? What are these common challenges?
Veronique: Indeed, very similar challenges when compared to Canada:
- Aging population with unique health, well-being and social needs
- Increased need for chronic disease prevention and management for all age groups
- Urgent need for a standardized approach to mental health challenges detection, prevention and management
- Limited health care dollars, shortage of workforce in health care (understaffing, recruitment and retention challenges)
- Siloed health care settings and system
- Large First Nations (Aboriginal) and immigrant population wiht different health care needs and delivery of services
- Large geographical area for care delivery, with many regions difficult or unable to access.
INsite: I understand you still make time to work as a gerontological nurse. Do you think it is important for researchers to retain a grounding in practice?
Veronique: I do believe it is important to have opportunities to ‘keep your finger on the pulse’ or ‘your ears to the ground’. In my clinical practice, I enjoy interacting and caring for the seniors and their families. I also stay informed on the latest care practices, I observe challenges in the care system and I am integrated within different teams of health care providers, so I am aware of what is happening in their day to day shifts. Nursing allows me to stay abreast of the day-to-day reality in seniors care, it allows me to pinpoint the ‘real’ problems and it even gives me opportunities to explore some innovative solutions that we otherwise might not think of. And, lastly, but probably most importantly, as a nurse, working in a strong care team, makes you realise that, together, you can make good things happen for those in your care. And that is what nursing is all about.
INsite: Which area of aged care is in need of more research, and why?
Veronique: More work needs to be done on the uptake of gerontological best practices. Several strong researchers have given us information why we should never use physical restraints with older people, or why one needs to tread carefully with psychoactive medications, or why bedrest is detrimental to older people’s health and mobility. Yet, somehow or another, that knowledge has not always been translated into best practices.
It is unacceptable that care practices, proven to cause harm to seniors, are still the ‘norm’ in some organizations. Lots of work for translational or implementation researchers and clinicians.
A second area of work needed to be completed is for the educators in our health care professionals. The novice healthcare workforce typically graduates not having the necessary gerontological competencies needed to care for the older adult population.
Nor do these new grads have a skill set in leadership, advocacy, quality management or leading (or being part of) a team. Again, this work must be done if we aim to change the status quo.
INsite: Have you been to New Zealand before? Any particular destinations or activities on your itinerary for this trip?
Veronique: Never! And very much looking forward to visiting the beautiful people, discovering the cities, nature and scenery, tasting the world-famous dishes and wine, and learning professionally from all of you.
Dr Veronique Boscart is a keynote speaker at 11am on Day 1 of the NZACA conference.