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COVID-19 pandemic: burdens on and consequences for nursing home staff
- Authors:
- HOED Manuela, THONHOFER Nina, SCHOBERER Daniela
- Journal article citation:
- Journal of Advanced Nursing, early cite March 2022,
- Publisher:
- Blackwells Publishing
The objective of this study was to assess burdens placed on and consequences of the COVID-19 pandemic on nursing home staff. Design: qualitative descriptive interview study. Methods: interviewed 18 nurses, nursing aides and care aides from five different nursing homes by using a semi-structured interview guideline between June and September 2020. Data were analysed with a qualitative content analysis method by combining an inductive and deductive coding frame. Results: Results show that the qualitative work load and work organization were major concerns. Regarding the qualitative work load, participants stated that they were required to perform additional tasks to care for residents, because the pandemic interventions placed the residents under stress and dealing with relatives presented significant challenges. Nursing home staff reported that psychological consequences such as uncertainty, fear and stress represented major effects of the COVID-19 situation. Conclusion: this study could show that qualitative workloads were assessed and perceived differently. Most nursing home care staff members experienced the changes in working conditions as both physically and psychologically challenging. Impact: this study highly recommends that nursing home staff receive support in such pandemics by being allowed, for example personal protective equipment breaks. Individually tailored programs need to be established to enhance wellbeing and decrease psychological stress and fear in such challenging times. (Edited publisher abstract)
What does it take to scale‐up a complex intervention? Lessons learned from the Connect‐Home transitional care intervention
- Authors:
- LEEMAN Jennifer, TOLES Mark
- Journal article citation:
- Journal of Advanced Nursing, 76(1), 2020, pp.387-397..
- Publisher:
- Blackwells Publishing
Aims: To discuss the multiple phases of research done to plan for wide-scale implementation (i.e. scale-up) of Connect-Home, a complex nurse-develop intervention. Barker et al.’s (Implementation Science, 2016, 11, 12) framework for intervention scale-up is applied to address the methods used to answer the following four questions: ‘Who’ needs to be involved in scale-up? ‘What’ intervention and implementation strategies need to be taken to scale? ‘How’ will scale-up be achieved? And what contextual factors influence ‘when’ scale-up is or is not successful? Design: Discussion paper. Data Sources: Data sources include the experience of our research team, supported by literature and theory. The Connect-Home team conducted multiple research studies to plan for Connect-Home scale-up. Early studies (2008–2015) focused on formative work to design the Connect-Home intervention. Recent studies have involved successive pilot tests of Connect-Home's effectiveness, implementation, and scale-up (2015–2019). Implications for Nursing: This article describes a systematic approach that nurse researchers can apply to plan for taking their interventions to scale. Conclusions: Planning for scale-up early in the process of intervention development is essential to speeding the translation of effective interventions into wide-scale practice. Impact: This article details the methods that nursing researchers applied to develop and test the strategies needed to plan for taking a complex intervention to scale across multiple settings. The methods described are applicable to nursing and other health researchers’ development and scale-up of any complex intervention. (Edited publisher abstract)
Guilt, tears, and burnout-Impact of UK care home restrictions on the mental well-being of staff, families, and residents
- Authors:
- GIEBEL Clarissa, et al
- Journal article citation:
- Journal of Advanced Nursing, early cite February 2022,
- Publisher:
- Blackwells Publishing
Aims: The aim of this study was to explore the impact of the pandemic on the emotional and mental well-being of family carers, care home staff and residents, in light of changing restrictions, increased testing and vaccination rollout in the UK. Design: Longitudinal, qualitative semi-structured interview study. Methods: Remote semi-structured interviews were conducted with family carers of care home residents with dementia and care home staff from different care homes across the UK. Baseline and follow-up interviews were conducted in October/November 2020 and March 2021, respectively. Data were analysed using inductive thematic analysis involving members of the public with caring experiences. Results: In all, 42 family carers and care home staff participated at baseline, with 20 family carers and staff followed up. This study identified four themes: (1) Developing anger and frustration; (2) Impact on relationships; (3) Stress and burnout; and (4) Behavioural changes, and perceived impact on residents. The mental health of everyone involved, including family carers, care home staff and residents, has been negatively affected, and relationships between family carers and staff have been severely strained. There was a general lack of adequate mental health support, with little relief. Conclusions: The pandemic has had a detrimental impact on the lives of those surrounding care homes—from residents and staff to family carers. Consideration should be given on how to best support the mental health needs of all three groups, by providing adequate easily accessible mental health care for all. This should also focus on rebuilding the relationships between family carers and care home staff. Impact: This is the first paper to highlight the effects of the long-lasting and miscommunicated restrictions on residents, carers and care home staff, and highlight the urgent need for continued mental health support. (Edited publisher abstract)
Strategies associated with COVID-19 vaccine coverage among nursing home staff
- Authors:
- BERRY Sarah D., et al
- Journal article citation:
- Journal of the American Geriatrics Society, early cite November 2021,
- Publisher:
- Blackwells Publishing
Background: After the first of three COVID-19 vaccination clinics in U.S. nursing homes (NHs), the median vaccination coverage of staff was 37.5%, indicating the need to identify strategies to increase staff coverage. This study aimed to compare the facility-level activities, policies, incentives, and communication methods associated with higher staff COVID-19 vaccination coverage. Methods: Design Case-control analysis. Setting: Nationally stratified random sample of 1,338 U.S. NHs participating in the Pharmacy Partnership for Long-Term Care Program. Participants: Nursing home leadership Measurement: During February 4 - March 2, 2021, surveyed NHs with low (<35%), medium (40%–60%) and high (>75%) staff vaccination coverage, to collect information on facility strategies used to encourage staff vaccination. Cases were respondents with medium and high vaccination coverage, whereas controls were respondents with low coverage. This study used logistic regression modeling, adjusted for county and NH characteristics, to identify strategies associated with facility-level vaccination coverage. Results: This study obtained responses from 413 of 1,338 NHs (30.9%). Compared with facilities with lower staff vaccination coverage, facilities with medium or high coverage were more likely to have designated frontline staff champions (medium: adjusted odds ratio [aOR] 3.6, 95% CI 1.3–10.3; high: aOR 2.9, 95% CI 1.1–7.7) and set vaccination goals (medium: aOR 2.4, 95% 1.0–5.5; high: aOR 3.7, 95% CI 1.6–8.3). NHs with high vaccination coverage were more likely to have given vaccinated staff rewards such as T-shirts compared with NHs with low coverage (aOR 3.8, 95% CI 1.3–11.0). Use of multiple strategies was associated with greater likelihood of facilities having medium or high vaccination coverage: for example, facilities that used ≥9 strategies were three times more likely to have high staff vaccination coverage than facilities using <6 strategies (aOR 3.3, 95% CI 1.2–8.9). Conclusions: Use of designated champions, setting targets, and use of non-monetary awards, were associated with high NH staff COVID-19 vaccination coverage. (Edited publisher abstract)
Psychological impacts and online interventions of social isolation amongst older adults during COVID‐19 pandemic: a scoping review
- Authors:
- RODRIGUES Natalie Grace, et al
- Journal article citation:
- Journal of Advanced Nursing, early cite October 2021,
- Publisher:
- Blackwells Publishing
Aim: To summarise the psychological impacts of social isolation amongst older adults during COVID-19 and review the benefits and limitations of online interventions used to combat social isolation. Design: A scoping review was performed. Data Sources: A systematic search was performed from October 2020 to January 2021 in seven electronic databases: China National Knowledge Infrastructure (CNKI), PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Cochrane Library and Web of Science. A hand search of the reference lists of included papers and WHO publications was performed. Grey literature search was carried out from Scopus, ProQuest Dissertation and Google Scholar. Review Methods: Studies were screened, appraised and extracted independently by two reviewers. Thematic analysis was used to synthesise data, which were presented in a descriptive manner and organised into categories and themes. Results: Totally, 33 studies were included. Four themes and eight sub-themes emerged: (1) negative impacts and experiences of older adults during social isolation, (2) adopting coping behaviours in the midst of COVID-19, (3) online interventions to combat the consequences of social isolation, (4) barriers to online intervention. Conclusion: The COVID-19 pandemic has taken an emotional toll on older adults’ psychological wellbeing and has highlighted the untapped strengths of older adults facing isolation. Online interventions, which could be a new normal in the COVID era, were beneficial in combating social isolation. Strategies by various stakeholders were recommended to tackle the barriers of online interventions. Impact: With the COVID-19 pandemic still in progress, this review provides insights on the psychological impacts of social isolation amongst older adults. Nurses in the community and long-term care facilities could adopt strategies and online intervention to better support the older adults, contribute to a stronger COVID-19 response and support system, and an overall better road to recovery from this crisis. (Edited publisher abstract)
Older persons’ experiences of Reflective STRENGTH-Giving Dialogues – ‘It's a push to move forward’
- Authors:
- ABERG Cecilia, et al
- Journal article citation:
- Scandinavian Journal of Caring Sciences, 35(3), 2021, pp.779-787.
- Publisher:
- Blackwell Publishing
Rationale: Experiences of the innovative method Reflective STRENGTH-Giving Dialogue (STRENGTH), which is grounded in a lifeworld perspective and developed to improve quality of care, is described in this study. Innovative thinking in developing health and social care, which may include digital solutions, is required to ensure a meaningful and dignified life in old age. Aim: The aim of this study was to describe experiences of the intervention Reflective STRENGTH-Giving Dialogue from the perspective of older persons living with long-term health problems. Method; Individual qualitative interviews were conducted with 27 older persons who participated in the intervention. The older persons wrote notes from each dialogue in booklets, and the booklets became part of the study data, analysed with a Reflective Lifeworld Research approach. Results: STRENGTH is experienced as an opportunity to reflect upon life and identify small and large life projects. Dialogues that lead to change in thoughts and actions influence the older persons' well-being, sense of balance, joy and meaning in life. There is an experience of STRENGTH as a starting point and a push to move forward in an effort to experience joy and meaning in life when living with long-term health problems. Conclusions: STRENGTH has the potential to contribute to quality improvement in person-centred care and enhance meaning in life for older persons living with long-term health problems. However, the use of a digital tool in this particular context poses challenges that must be considered. (Edited publisher abstract)
A systematic review of long‐term care facility characteristics associated with COVID‐19 outcomes
- Authors:
- KONETZKA R. Tamara, et al
- Journal article citation:
- Journal of the American Geriatrics Society, 69(10), 2021, pp.2766-2777.
- Publisher:
- Blackwells Publishing
Background/Objectives: The coronavirus disease 2019 (COVID-19) pandemic has taken a disproportionate toll on long-term care facility residents and staff. Our objective was to review the empirical evidence on facility characteristics associated with COVID-19 cases and deaths. Design: Systematic review. Setting: Long-term care facilities (nursing homes and assisted living communities). Participants: Thirty-six empirical studies of factors associated with COVID-19 cases and deaths in long-term care facilities published between January 1, 2020 and June 15, 2021. Measurements: Outcomes included the probability of at least one case or death (or other defined threshold); numbers of cases and deaths, measured variably. Results: Larger, more rigorous studies were fairly consistent in their assessment of risk factors for COVID-19 outcomes in long-term care facilities. Larger bed size and location in an area with high COVID-19 prevalence were the strongest and most consistent predictors of facilities having more COVID-19 cases and deaths. Outcomes varied by facility racial composition, differences that were partially explained by facility size and community COVID-19 prevalence. More staff members were associated with a higher probability of any outbreak; however, in facilities with known cases, higher staffing was associated with fewer deaths. Other characteristics, such as Nursing Home Compare 5-star ratings, ownership, and prior infection control citations, did not have consistent associations with COVID-19 outcomes. Conclusion: Given the importance of community COVID-19 prevalence and facility size, studies that failed to control for these factors were likely confounded. Better control of community COVID-19 spread would have been critical for mitigating much of the morbidity and mortality long-term care residents and staff experienced during the pandemic. Traditional quality measures such as Nursing Home Compare 5-Star ratings and past deficiencies were not consistent indicators of pandemic preparedness, likely because COVID-19 presented a novel problem requiring extensive adaptation by both long-term care providers and policymakers. (Edited publisher abstract)
A systematic review of long-term care facility characteristics associated with COVID-19 outcomes
- Authors:
- KONETZKA R. Tamara, et al
- Journal article citation:
- Journal of the American Geriatrics Society, early cite September 2021,
- Publisher:
- Blackwells Publishing
Background/Objectives: The coronavirus disease 2019 (COVID-19) pandemic has taken a disproportionate toll on long-term care facility residents and staff. Our objective was to review the empirical evidence on facility characteristics associated with COVID-19 cases and deaths. Design: Systematic review. Setting: Long-term care facilities (nursing homes and assisted living communities). Participants: Thirty-six empirical studies of factors associated with COVID-19 cases and deaths in long-term care facilities published between January 1, 2020 and June 15, 2021. Measurements: Outcomes included the probability of at least one case or death (or other defined threshold); numbers of cases and deaths, measured variably. Results: Larger, more rigorous studies were fairly consistent in their assessment of risk factors for COVID-19 outcomes in long-term care facilities. Larger bed size and location in an area with high COVID-19 prevalence were the strongest and most consistent predictors of facilities having more COVID-19 cases and deaths. Outcomes varied by facility racial composition, differences that were partially explained by facility size and community COVID-19 prevalence. More staff members were associated with a higher probability of any outbreak; however, in facilities with known cases, higher staffing was associated with fewer deaths. Other characteristics, such as Nursing Home Compare 5-star ratings, ownership, and prior infection control citations, did not have consistent associations with COVID-19 outcomes. Conclusion: Given the importance of community COVID-19 prevalence and facility size, studies that failed to control for these factors were likely confounded. Better control of community COVID-19 spread would have been critical for mitigating much of the morbidity and mortality long-term care residents and staff experienced during the pandemic. Traditional quality measures such as Nursing Home Compare 5-Star ratings and past deficiencies were not consistent indicators of pandemic preparedness, likely because COVID-19 presented a novel problem requiring extensive adaptation by both long-term care providers and policymakers. (Edited publisher abstract)
Deprivation and intra-family conflict: children as agents in the Family Stress Model
- Authors:
- CHZHEN Yekaterina, HOWARTH Chester, MAIN Gill
- Journal article citation:
- Journal of Marriage and Family, early cite 30 July 2021,
- Publisher:
- Blackwell Publishing
- Place of publication:
- Oxford
Objective: The study applies an adapted Family Stress Model (FSM) to analyze the relationship between child material deprivation and intra-family conflict about money using a nationally representative survey of children in England in 2018. Background: The standard FSM holds that poverty is experienced by parents who, in turn, impact children. Drawing on new social studies of childhood, the authors posit that the model does not recognize children as social actors - with direct experiences of poverty - nor as social agents who co-construct parent-child relationships in a context of poverty. Method: The authors use secondary survey data from Fair Shares and Families, which investigated children's and parents' experiences of, and involvement in, the sharing of family resources. The authors estimate linear structural equation models to test an adapted FSM, which includes separate pathways (for parents and children) from economic hardship to intra-family conflict. Results: Both parent- and child-reported economic pressure and psychological distress have significant direct and indirect associations with intra-family conflict. The adapted model works the same way in lower and higher income households, as well as in lone parent and couple-headed families. Conclusion: Children's experiences as social actors and influence as social agents are important in shaping parent-child relationships. This suggests that the standard FSM is limited in its insights about how economic hardship affects children and families and its policy applications for interventions to mitigate the impacts of child poverty. Research applying the FSM should seek to conceptualize children as active “child-beings,” rather than as passive “adult-becomings.” (Edited publisher abstract)
Application of the Haddon matrix to COVID-19 prevention and containment in nursing homes
- Authors:
- FRITCH William M., et al
- Journal article citation:
- Journal of the American Geriatrics Society, ealry cite July 2021,
- Publisher:
- Blackwells Publishing
COVID-19 has exacted a disproportionate toll on the health of persons living in nursing homes. Healthcare providers and other decision-makers in those settings must refer to multiple evolving sources of guidance to coordinate care delivery in such a way as to minimize the introduction and spread of the causal virus, SARS-CoV-2. It is essential that guidance be presented in an accessible and usable format to facilitate its translation into evidence-based best practice. This article proposes the Haddon matrix as a tool well-suited to this task. The Haddon matrix is a conceptual model that organizes influencing factors into pre-event, event, and post-event phases, and into host, agent, and environment domains akin to the components of the epidemiologic triad. The Haddon matrix has previously been applied to topics relevant to the care of older persons, such as fall prevention, as well as to pandemic planning and response. Presented here is a novel application of the Haddon matrix to pandemic response in nursing homes, with practical applications for nursing home decision-makers in their efforts to prevent and contain COVID-19. (Edited publisher abstract)