A qualitative assessment of factors affecting nursing home caregiving staff experiences during the COVID-19 pandemic

Background A large portion of COVID-19 cases and deaths in the United States have occurred in nursing homes; however, current literature including the frontline perspective of staff working in nursing homes is limited. The objective of this qualitative assessment was to better understand what individual and facility level factors may have contributed to the impact of COVID-19 on Certified Nursing Assistants (CNAs) and Environmental Services (EVS) staff working in nursing homes. Methods Based on a simple random sample from the National Healthcare Safety Network (NHSN), 7,520 facilities were emailed invitations requesting one CNA and/or one EVS staff member for participation in a voluntary focus group over Zoom. Facility characteristics were obtained via NHSN and publicly available sources; participant demographics were collected via SurveyMonkey during registration and polling during focus groups. Qualitative information was coded using NVIVO and Excel. Results Throughout April 2021, 23 focus groups including 110 participants from 84 facilities were conducted homogenous by participant role. Staffing problems were a recurring theme reported. Participants often cited the toll the pandemic took on their emotional well-being, describing increased stress, responsibilities, and time needed to complete their jobs. The lack of consistent and systematic guidance resulting in frequently changing infection prevention protocols was also reported across focus groups. Conclusions Addressing concerns of low wages and lack of financial incentives may have the potential to attract and retain employees to help alleviate nursing home staff shortages. Additionally, access to mental health resources could help nursing home staff cope with the emotional burden of the COVID-19 pandemic. These frontline staff members provided invaluable insight and should be included in improvement efforts to support nursing homes recovering from the impact of COVID-19 as well as future pandemic planning.

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Visitor restrictions during the COVID-19 pandemic: An ethical case study

Nursing Ethics ◽

10.1177/09697330211005078 ◽

2021 ◽

pp. 096973302110050

Author(s):

Irene Hartigan ◽

Ann Kelleher ◽

Joan McCarthy ◽

Nicola Cornally

Keyword(s):

Public Health ◽

Nursing Home ◽

Nursing Homes ◽

Ethical Decision Making ◽

Clinical Status ◽

Well Being ◽

World Health ◽

Nursing Home Staff ◽

Regulatory Bodies ◽

The Impact

To prevent and reduce the transmission of the coronavirus to vulnerable populations, the World Health Organization recommended the restriction of visitors to nursing homes. It was recognised that such restrictions could have profound impact on residents and their families. Nonetheless, these measures were strictly imposed over a prolonged period in many countries; impeding families from remaining involved in their relatives’ care and diluting the meaningful connections for residents with society. It is timely to explore the impact of public health measures on people living in nursing homes from an ethical perspective. In order to foreground the ethical dimensions of the implications of visitor restrictions in nursing homes, we compiled an ethical case that reflects some recent experiences of nursing homes residents and their families, in the Irish Republic. We describe a series of events encountered by a woman and her family during the first wave of the pandemic in 2020 and we deploy an ethical decision-making tool to guide and structure our analysis. Our case analysis draws attention to ethical principles that are relevant to explicating the ethical duties and obligations that arise in relation to the interests, well-being, and safety of residents and their families, as well as nursing home staff and the wider community during a pandemic. These include the right of autonomy, trust, minimising harm, and proportionality. We conclude that a number of different strategies should be adopted by nursing homes and relevant regulatory bodies. This includes honest, regular communication between the nursing home staff, the resident and their family. Central to communications is the resident’s wishes, their current clinical status and the all-important wider public health obligations. National strategies include mass vaccination, the timely provision of guidance documents and interventions from regulatory bodies that are patient-centred, adaptable, and cost effective.

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The meaning of working in a person-centred way in nursing homes: a phenomenological-hermeneutical study

BMC Nursing ◽

10.1186/s12912-019-0372-9 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 3

Author(s):

Tove K. Vassbø ◽

Marit Kirkevold ◽

David Edvardsson ◽

Karin Sjögren ◽

Qarin Lood ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Lived Experiences ◽

Well Being ◽

Psychological State ◽

Nursing Home Staff ◽

Daily Work ◽

Care Approach ◽

One Year ◽

Thriving At Work

Abstract Background The present study aims to illuminate the meaning of working in a person-centred way as experienced by staff in nursing homes. Insights into what working in a person-centred way mean for nursing home staff may contribute to a more comprehensive understanding of what gives staff satisfaction in their work and support further development of person-centred care approach in nursing homes. Methods Interviews with 29 health care personnel who had participated in a one-year intervention focusing on person-centred care and thriving in three nursing homes in Australia, Norway and Sweden were performed, and a phenomenological-hermeneutical method was used to explore staffs’ lived experiences of working in a person-centred way in nursing homes. Results For nursing home staff, working in a person-centred way meant that they were able to meet individual resident’s needs and expressed preferences in close family-like relationships, understanding the residents’ rhythms and preferences as the basis of the daily work plans and being able to do ‘the little extra’ for residents. Also, working in a person-centred way meant meeting shared goals by working towards a collective practice in collaborative teams. As a whole, the staffs’ lived experiences of working in a person-centred way in nursing homes was interpreted to mean thriving at work as a psychological state in which individuals experience both a sense of vitality and learning. Conclusions Working in a person-centred way means staff thriving at work in nursing homes. The results further indicate that delivering care by only focusing on routines and practical tasks and not on residents’ preferences and well-being would inhibit thriving among nursing staff, leading to the potential for dissatisfaction with work.

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A qualitative examination of the impacts of financial stress on college students’ well-being: Insights from a large, private institution

SAGE Open Medicine ◽

10.1177/20503121211018122 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110181

Author(s):

Andrea Moore ◽

Annie Nguyen ◽

Sabrina Rivas ◽

Ayah Bany-Mohammed ◽

Jarod Majeika ◽

...

Keyword(s):

College Students ◽

Focus Groups ◽

Negative Impact ◽

Qualitative Content Analysis ◽

Group Analysis ◽

Financial Stress ◽

Well Being ◽

The United States ◽

Major Theme ◽

The Impact

Objective: This qualitative research aims to provide deeper insight into college students’ experiences by examining the impact of financial stress on their well-being. Methods: Four focus groups were conducted at a large, private, urban university in the United States over the course of 1 month, each lasting approximately 1 h. Facilitators used a structured moderator guide to maintain consistency. Four focus groups were conducted and a total of 30 students participated. Students were primarily Asian (66.7%) and White (30.0%), and a majority were female (86.7%). Student participants were 43.3% undergraduate and 56.6% graduate. Transcripts were analyzed in Atlas.ti 8 software using line-by-line open coding guided by the principles of qualitative content analysis. An inductive approach was utilized to code the data. Emergent categories and concepts were then organized hierarchically into themes and subthemes. Results: Two overarching themes emerged from the focus group analysis. In these students’ perspectives, financial stress impedes their ability to succeed academically. Another major theme is the impact of finances on students’ social lives. Students experiencing financial stress find it challenging to navigate relationships with wealthier peers, often leading to feelings of isolation and embarrassment. Conclusion: Given the reported negative impact on students’ well-being, further research is needed to determine methods for mitigating financial stress.

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Relationship between nursing home COVID-19 outbreaks and staff neighborhood characteristics

10.1101/2020.09.10.20192203 ◽

2020 ◽

Author(s):

Karen Shen

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Public Transportation ◽

The United States ◽

Early Summer ◽

Facility Management ◽

Neighborhood Characteristics ◽

Term Care ◽

Nursing Home Staff ◽

Combining Data

AbstractThe COVID-19 pandemic has been particularly deadly for residents of nursing homes and other long-term care facilities. This paper analyzes COVID-19 deaths at nursing homes during the first wave of the pandemic in the United States during the spring and early summer 2020. By combining data on facility-level COVID-19 deaths during this period with data on the neighborhoods where nursing home staff reside for a sample of eighteen states, this paper finds that staff neighborhood characteristics were a large and significant predictor of COVID-19 nursing home deaths. Even after controlling for the county where a facility is located, one standard deviation increases in average staff neighborhood (Census tract) population density, public transportation use, and non-white share were associated with 1.3 (p < .001), 1.4 (p<.001), and 0.9 (p<.001) additional deaths per 100 beds, respectively. These effects are larger than all facility management or quality variables, and larger than the effect of the nursing home’s own neighborhood characteristics. These results suggest COVID-19 outbreaks in staff communities can have large consequences for the facilities where they work, even in highly-rated facilities, and that disparities in nursing home outbreaks may be related to differences in the types of neighborhoods nursing home staff live in.

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Abstract WP383: An Economic Model of Improved Acute Stroke Care in the Management of Acute Ischemic Stroke From A State Medicaid Perspective

Stroke ◽

10.1161/str.44.suppl_1.awp383 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Zheng-Yi Zhou ◽

Liangyi Fan ◽

Er Chen ◽

Jipan Xie ◽

Eric Q Wu

Keyword(s):

Ischemic Stroke ◽

Nursing Home ◽

Nursing Homes ◽

Acute Ischemic Stroke ◽

Economic Model ◽

Stroke Care ◽

The United States ◽

Absolute Increase ◽

Medicaid Spending ◽

The Impact

Background: Stroke is a leading cause of long-term disability in the United States. Approximately one in four stroke survivors is admitted to a nursing home, accounting for a significant portion of Medicaid spending on stroke. Objective: To assess the impact of increasing access to primary stroke centers (PSCs) and implementing an emergency medical services (EMS) system on disability and Medicaid spending on nursing homes for ten geographically representative states. Methods: An economic model was developed to estimate potential reductions in stroke-related disability and corresponding reductions in Medicaid spending on nursing homes among Medicaid enrollees with acute ischemic stroke (AIS), due to improved stroke care infrastructure. The model assessed the increased use of intravenous (IV) thrombolysis as a result of a higher proportion of AIS treated in PSCs, or as a result of integrating an EMS system with PSCs. Based on published literature, more patients received IV thrombolysis in PSCs vs. non-PSCs (6.5 vs. 0.9%) and PSCs with an EMS routing protocol vs local services (10.5 vs. 2.5%). State-specific model inputs included the incidence of first-ever AIS in Medicaid enrollees, nursing home costs, and Medicaid spending on stroke-related care. Results: A 20% absolute increase in the proportion of AIS patients treated at PSCs will lead to 111 to 2004 more patients receiving IV thrombolysis; 9 to 160 fewer patients with disability; and a reduction in Medicaid nursing home spending of $299,442 to $5.6 million per year across the ten states analyzed (Table). The integration of an EMS system with PSCs will lead to 791 to 14,314 more patients receiving IV thrombolysis; 63 to 1145 fewer patients with disability; and a reduction in Medicaid nursing home spending of $2.1 to $40.0 million per year across the ten states (Table). Conclusions: States may achieve substantial savings through legislative policies that improve PSC access and integration of an EMS system with PSCs.

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The Impact of Myelodysplastic Syndromes on Patients’ Lives.

Blood ◽

10.1182/blood.v106.11.2544.2544 ◽

2005 ◽

Vol 106 (11) ◽

pp. 2544-2544

Author(s):

Mary L. Thomas ◽

Kathleen Heptinstall ◽

Audrey Hassan

Keyword(s):

Focus Groups ◽

Myelodysplastic Syndromes ◽

Negative Impact ◽

Well Being ◽

The United States ◽

Emotional Reactions ◽

Current Status ◽

Treatment Modalities ◽

Office Visits ◽

The Impact

Abstract While recent research has greatly enhanced understanding of the pathology of the disease, and new treatment modalities have been developed, little is known about myelodysplastic syndromes (MDS) from the patient’s perspective. The purpose of this qualitative study was to explore the impact of MDS on patients’ quality of life (QOL). Five focus groups were convened at different geographic locations throughout the United States; 70 MDS patients attended and 62 actively participated in the discussions (89%). The framework for the study was based on Ferrell’s work exploring the impact of cancer on QOL (Oncology Nursing Forum, 1996). Exploratory in nature, the discussions often proceeded in differing directions, but the core open-ended questions were asked at each session. Sessions were tape recorded and professionally transcribed. Transcripts were coded and emerging themes identified using thematic analysis methods aided by the qualitative analysis program N5 (QSR International). The patient sample was 93% Caucasian, 51% male, with a mean age of 69 ± 9 years; 26% lived alone. Known MDS subtype was: 19 RA, 19 RARS, 11 RAEB, 3 5q-, 2 other (16 unknown); median time since diagnosis was 26 months (3 – 276 months). MDS treatment varied considerably: 73% of patients received growth factors, 61% transfusions, 19% azacitidine, 16% thalidomide, 14% iron chelation; 29% all other; many patients received multiple (often concurrent) therapies. Findings from the focus groups revealed a multifaceted description of how MDS can affect one’s QOL. QOL was typically defined by these patients as maintaining functional ability and independence, sustaining positive relationships, and maintaining control over one’s life. In contrast, MDS was found to cause a substantial and sustained decrease in one’s ability to function in a variety of areas, in part due to fatigue (reported by 81% of the patients). QOL was adversely affected by the work expended on managing the disease: frequent office visits, monitoring symptoms, administering therapy, and managing side effects. Family functioning was also disrupted, with family members resuming patients’ roles, limiting activities, and providing direct care. Interestingly, the emotional impact from MDS was often viewed as more problematic than the physical impact; emotional reactions included shock, anger, depression, and anxiety. In contrast, spiritual well-being was often enhanced, with a renewed appreciation for life, relationships, and faith (29% of patients). Many patients (50%) voiced concern about their future and the inability to plan for it effectively. Frustration with their current status caused the majority of patients to continue to seek out additional information about MDS and potential treatment options, as well as to make attempts to take some control over a seemingly uncontrolled situation. Data from this study suggest that MDS has a substantial, often negative impact on patients’ lives, and clinicians should be cognizant of this impact. Moreover, attention must be directed at providing more comprehensive support for the patient, including utilizing ancillary support services, throughout the illness trajectory. In so doing, the adverse impact of MDS on patients’ QOL may be diminished.

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The link between coronavirus, anxiety, and religious beliefs in the United States and United Kingdom

10.31234/osf.io/wykeq ◽

2020 ◽

Cited By ~ 1

Author(s):

Francesco Rigoli

Keyword(s):

United States ◽

United Kingdom ◽

Religious Beliefs ◽

Well Being ◽

The United States ◽

Christian Faith ◽

Stressful Event ◽

Cultural Implications ◽

The Impact

Research has shown that stress impacts on people’s religious beliefs. However, several aspects of this effect remain poorly understood, for example regarding the role of prior religiosity and stress-induced anxiety. This paper explores these aspects in the context of the recent coronavirus emergency. The latter has impacted dramatically on many people’s well-being; hence it can be considered a highly stressful event. Through online questionnaires administered to UK and USA citizens professing either Christian faith or no religion, this paper examines the impact of the coronavirus crisis upon common people’s religious beliefs. We found that, following the coronavirus emergency, strong believers reported higher confidence in their religious beliefs while non-believers reported increased scepticism towards religion. Moreover, for strong believers, higher anxiety elicited by the coronavirus threat was associated with increased strengthening of religious beliefs. Conversely, for non-believers, higher anxiety elicited by the coronavirus thereat was associated with increased scepticism towards religious beliefs. These observations are consistent with the notion that stress-induced anxiety enhances support for the ideology already embraced before a stressful event occurs. This study sheds light on the psychological and cultural implications of the coronavirus crisis, which represents one of the most serious health emergencies in recent times.

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The impact of COVID-19 on the well-being and cognition of older adults living in the United States and Latin America

EClinicalMedicine ◽

10.1016/j.eclinm.2021.100848 ◽

2021 ◽

Vol 35 ◽

pp. 100848

Author(s):

Ganesh M. Babulal ◽

Valeria L. Torres ◽

Daisy Acosta ◽

Cinthya Agüero ◽

Sara Aguilar-Navarro ◽

...

Keyword(s):

United States ◽

Older Adults ◽

Latin America ◽

Well Being ◽

The United States ◽

The Impact

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SEM-PLS Approach to Green Building

Encyclopedia ◽

10.3390/encyclopedia1020039 ◽

2021 ◽

Vol 1 (2) ◽

pp. 472-481

Author(s):

Nasim Aghili ◽

Mehdi Amirkhani

Keyword(s):

Structural Equation ◽

Green Building ◽

Well Being ◽

The United States ◽

Assessment Method ◽

Assessment System ◽

Renewable Materials ◽

Sustainable Building ◽

Building Operation ◽

The Impact

Green buildings refer to buildings that decrease adverse environmental effects and maintain natural resources. They can diminish energy consumption, greenhouse gas emissions, the usage of non-renewable materials, water consumption, and waste generation while improving occupants’ health and well-being. As such, several rating tools and benchmarks have been developed worldwide to assess green building performance (GBP), including the Building Research Establishment Environmental Assessment Method (BREEAM) in the United Kingdom, German Sustainable Building Council (DGNB), Leadership in Energy and Environmental Design (LEED) in the United States and Canada, Comprehensive Assessment System for Built Environment Efficiency (CASBEE) in Japan, Green Star in Australia, Green Mark in Singapore, and Green Building Index in Malaysia. Energy management (EM) during building operation could also improve GBP. One of the best approaches to evaluating the impact of EM on GBP is by using structural equation modelling (SEM). SEM is a commanding statistical method to model testing. One of the most used SEM variance-based approaches is partial least squares (PLS), which can be implemented in the SmartPLS application. PLS-SEM uses path coefficients to determine the strength and significance of the hypothesised relationships between the latent constructs.

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Understanding the Link between Family Caregiver Quality of Life and the Care Provided to Older People With Dementia

Innovation in Aging ◽

10.1093/geroni/igaa057.500 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 153-154

Author(s):

Afeez Hazzan

Keyword(s):

Quality Of Life ◽

Quality Of Care ◽

Older People ◽

Family Caregivers ◽

Family Caregiver ◽

Well Being ◽

The United States ◽

People With Dementia ◽

The Impact

Abstract Dementia is one of the most rapidly growing diseases in the United States. In 2018, the direct costs to American society of caring for older people with dementia was approximately $277 billion. Primary informal caregivers are mainly responsible for the care of older people with dementia including Alzheimer’s disease. Caregivers perform a myriad of duties ranging from shopping for their loved ones’ groceries, helping with medications, and managing finances. The caregiving role becomes more demanding as the disease progresses over time, and studies have shown that the quality-of-life (QoL) experienced by caregivers of older adults who have dementia is lower than the QoL of caregivers for older people who do not have dementia. To the best of our knowledge, there has been no research conducted to investigate whether lower caregiver QoL affects the level or quality of care that caregivers provide to persons with dementia. In the current study, we interviewed family caregivers living in Rochester, New York to inquire about their quality of life and the care provided to older people living with dementia. Further, caregivers completed the 36-item Short Form Health Survey (SF-36) as well as a draft questionnaire for measuring the quality of care provided to older people living with dementia. Both quantitative and qualitative findings from this study reveals important relationships between family caregiver QoL and the care provided, including the impact of social support and financial well-being. The study findings could have significant impact, particularly for the provision of much needed support for family caregivers.

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