1
|
Leland NE, Brown C, Shore AD, Cary MP, Reed K, Saliba D. Efforts to Support the Mental Health and Well-being of Nursing Home Staff: Insights From Leaders. J Am Med Dir Assoc 2024; 25:105051. [PMID: 38830597 PMCID: PMC11283949 DOI: 10.1016/j.jamda.2024.105051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES The sustained stress and trauma experienced by frontline nursing home (NH) staff throughout the COVID-19 pandemic has been described in health care literature and popular press. Yet, limited attention has been given to attempts to support NH staff. The objective of this study was to examine efforts to support the mental health and well-being of NH staff during the COVID-19 pandemic. DESIGN Qualitative, multiple-case-study design that purposively sampled NHs from 3 groups based on the Centers for Medicare & Medicaid Services NH 5-star quality performance ratings [ie, high (4-5-star), medium (3-star), and low (1-2-star)]. SETTINGS AND PARTICIPANTS Ninety-four US NH leaders participated in semistructured interviews via phone, between January 2021 and December 2022. METHODS A 3-step rapid qualitative analysis process was used to conduct a thematic analysis. RESULTS Five themes emerged as NH leaders described strategies used to address the mental health and well-being of their staff, including (1) efforts to address stressors in staff's personal lives (eg, risk of COVID-19 transmission to families, finances), (2) providing mental health services (eg, counseling, Employee Assistance Program) and resources (eg, staff self-care, mindfulness), (3) appreciation initiatives to combat negative media portrayals of NHs, (4) fostering an environment that supports mental health and well-being (eg, leadership initiatives to prioritize mental health, embedding training on burnout into standing meetings), and (4) modifying staff benefits (eg, expanding mental health coverage within staff insurance plan, paid time off). CONCLUSIONS In light of concerns about NH staffing levels and the recently proposed minimum staffing levels, there is a need to design and evaluate initiatives to recruit and retain qualified NH staff. Insights into efforts implemented by NH leaders to improve mental health and well-being can inform the design of future efforts to improve staff retention.
Collapse
Affiliation(s)
- Natalie E Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Cait Brown
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Amanda D Shore
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Kathryn Reed
- Department of Physician Assistant Studies, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Debra Saliba
- Geriatric Research Education and Clinical Center (GRECC) Greater Los Angeles VA, Los Angeles, CA, USA; The Anna and Harry Borun Center for Gerontological Research, Geriatric Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
2
|
Shaw RL, Morrison R, Webb S, Balogun O, Duncan HP, Butcher I. Challenges to well-being in critical care. Nurs Crit Care 2024; 29:745-755. [PMID: 38233201 DOI: 10.1111/nicc.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Paediatric critical care (PCC) is a high-pressure working environment. Staff experience high levels of burnout, symptoms of post-traumatic stress, and moral distress. AIM To understand challenges to workplace well-being in PCC to help inform the development of staff interventions to improve and maintain well-being. STUDY DESIGN The Enhanced Critical Incident Technique (ECIT) was used. ECIT encompasses semi-structured interviews and thematic analysis. We identified 'critical incidents', challenges to well-being, categorized them in a meaningful way, and identified factors which helped and hindered in those moments. Fifty-three nurses and doctors from a large UK quaternary PCC unit were consented to take part. RESULTS Themes generated are: Context of working in PCC, which examined staff's experiences of working in PCC generally and during COVID-19; Patient care and moral distress explored significant challenges to well-being faced by staff caring for increasingly complex and chronically ill patients; Teamwork and leadership demonstrated the importance of team-belonging and clear leadership; Changing workforce explored the impact of staffing shortages and the ageing workforce on well-being; and Satisfying basic human needs, which identified absences in basic requirements of food and rest. CONCLUSIONS Staff's experiential accounts demonstrated a clear need for psychologically informed environments to enable the sharing of vulnerabilities, foster support, and maintain workplace well-being. Themes resonated with the self-determination theory and Maslow's hierarchy of needs, which outline requirements for fulfilment (self-actualization). RELEVANCE TO CLINICAL PRACTICE Well-being interventions must be informed by psychological theory and evidence. Recommendations are flexible rostering, advanced communication training, psychologically-informed support, supervision/mentoring training, adequate accommodation and hot food. Investment is required to develop successful interventions to improve workplace well-being.
Collapse
Affiliation(s)
- Rachel L Shaw
- Institute of Health & Neurodevelopment, College of Health & Life Sciences, Aston University, Birmingham, UK
| | - Rachael Morrison
- Paediatric Critical Care, Birmingham Children's Hospital, Birmingham, UK
| | - Sarah Webb
- Paediatric Critical Care, Birmingham Children's Hospital, Birmingham, UK
| | - Omobolanle Balogun
- Institute of Health & Neurodevelopment, College of Health & Life Sciences, Aston University, Birmingham, UK
| | - Heather P Duncan
- Paediatric Critical Care, Birmingham Children's Hospital, Birmingham, UK
| | | |
Collapse
|
3
|
Corridan CL, Dawson SE, Mullan S. Potential Benefits of a 'Trauma-Informed Care' Approach to Improve the Assessment and Management of Dogs Presented with Anxiety Disorders. Animals (Basel) 2024; 14:459. [PMID: 38338102 PMCID: PMC10854685 DOI: 10.3390/ani14030459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 02/12/2024] Open
Abstract
Dog caregiver reporting on the spectrum of fearful-aggressive behaviours often describes 'unpredictable' or 'exaggerated' responses to a situation/animal/person. A possible explanation for these behavioural responses considers that the dog is reacting to triggered memories for which the dog has a negative association. For many dogs undergoing veterinary behavioural treatment or rehabilitation through a canine rescue organisation, the assessing clinician relies on "proxy" reporting of the history/background by a caregiver (dog owner, foster carer, or shelter personnel). Detailed information on the event or circumstances resulting in this negative association may be limited or absent altogether. Consideration of a trauma-informed care (TIC) approach, currently applied in a wide range of human psychology and social care fields, may be helpful in guiding the clinical approach taken. The literature relating to adverse early experience (AEE) and trauma-informed care (TIC) in puppies/dogs compared to children/adults was evaluated to identify common themes and conclusions identified across both species. In the absence of known/identifiable trauma, behavioural assessment and management should consider that a 'problem' dog may behave as it does, as the result of previous trauma. The dog can then be viewed through a lens of empathy and understanding, often lacking for dogs presenting with impulsive, reactive, or aggressive behaviours. Assessment must avoid re-traumatising the animal through exposure to triggering stimuli and, treatment options should include counselling of caregivers on the impact of adverse early experiences, consideration of the window of tolerance, and TIC behavioural modification techniques.
Collapse
Affiliation(s)
| | - Susan E. Dawson
- Research Fellow in Psychology, University of Manchester, Manchester M13 9PL, UK
| | - Siobhan Mullan
- Animal Welfare & Ethics, UCD School of Veterinary Science, Belfield, D04 V1W8 Dublin, Ireland;
| |
Collapse
|
4
|
MacRae A, Berkovic D, Ryan J, Hatzikiriakidis K, Ayton D. Trauma-informed care within residential aged care settings: A systematic scoping review. Int J Geriatr Psychiatry 2023; 38:e6028. [PMID: 38038652 DOI: 10.1002/gps.6028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/12/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES The importance of trauma-informed care (TIC) within residential aged care (RAC) settings has been increasingly recognised. TIC would ensure that older people who have experienced trauma over their lifetime have their needs better understood and accommodated. This scoping review examined the extent to which TIC has been applied within RAC settings. METHODS A scoping review was conducted according to Cochrane recommendations and the PRISMA-ScR checklist. A systematic search of six databases (Embase, Emcare, CENTRAL, CINAHL, PsychInfo and Medline) was performed in July 2022 and March 2023 and peer-reviewed primary research, in English and involved RAC staff or residents (aged 65 years and over) providing or receiving TIC were eligible for inclusion. Studies focused on trauma intervention, assessment, screening, or treatment were excluded. Thematic synthesis was performed to extract themes relating to trauma-informed practice, barriers and enablers to TIC, and outcomes from the application of TIC approaches. RESULTS Five articles were included. There was little evidence of the implementation of TIC interventions in RAC settings. Only one study examined the application of a TIC framework in a RAC setting. However, there was some evidence that approaches that consider resident's experience of trauma have emerged from practice experience and been used in RAC as an extension of person-centred care. CONCLUSIONS Whilst trauma-informed approaches to resident care are emerging through practice experience, and despite policy recommendations to do so, there is little evidence that formal TIC interventions or frameworks have been applied to RAC internationally. This study highlights a gap in research and practice and makes several recommendations for further research and implementation of TIC in RAC.
Collapse
Affiliation(s)
- Ann MacRae
- Health and Social Care Unit, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Danielle Berkovic
- Musculoskeletal Health and Wiser Healthcare Unit, Monash University School of Public Health and Preventive Medicine, Melbourne, Southeastern Australian, Australia
| | - Joanne Ryan
- Monash University School of Public Health and Preventive Medicine, Melbourne, Southeastern Australian, Australia
| | - Kostas Hatzikiriakidis
- Health and Social Care Unit, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Darshini Ayton
- Health and Social Care Unit, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Thwaites C, McKercher JP, Fetherstonhaugh D, Blackberry I, Gilmartin-Thomas JFM, Taylor NF, Bourke SL, Fowler-Davis S, Hammond S, Morris ME. Factors Impacting Retention of Aged Care Workers: A Systematic Review. Healthcare (Basel) 2023; 11:3008. [PMID: 38063576 PMCID: PMC10706301 DOI: 10.3390/healthcare11233008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/13/2023] [Accepted: 11/19/2023] [Indexed: 10/16/2024] Open
Abstract
Retention of care support workers in residential aged care facilities and home-based, domiciliary aged care is a global challenge, with rapid turnover, low job satisfaction, and poorly defined career pathways. A mixed-methods systematic review of the workforce literature was conducted to understand the factors that attract and retain care staff across the aged care workforce. The search yielded 49 studies. Three studies tested education and training interventions with the aim of boosting workforce retention and the remaining 46 studies explored opinions and experiences of care workers in 20 quantitative, four mixed-methods and 22 qualitative studies. A range of factors impacted retention of aged care staff. Two broad themes emerged from the analysis: individual and organisational factors facilitating retention. Individual factors related to personal satisfaction with the role, positive relationships with other staff, families, and residents, and a cooperative workplace culture. Organisational factors included opportunities for on-the-job training and career development, appropriate wages, policies to prevent workplace injuries, and job stability. Understaffing was often cited as a factor associated with turnover, together with heavy workloads, stress, and low job satisfaction. With global concerns about the safety and quality of aged care services, this study presents the data associated with best practice for retaining aged care workers.
Collapse
Affiliation(s)
- Claire Thwaites
- Academic and Research Collaborative in Health, La Trobe University, Melbourne, VIC 3086, Australia; (J.P.M.); (N.F.T.); (S.L.B.); (M.E.M.)
- Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Melbourne, VIC 3150, Australia;
| | - Jonathan P. McKercher
- Academic and Research Collaborative in Health, La Trobe University, Melbourne, VIC 3086, Australia; (J.P.M.); (N.F.T.); (S.L.B.); (M.E.M.)
| | - Deirdre Fetherstonhaugh
- Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, VIC 3086, Australia;
| | - Irene Blackberry
- Care Economy and Research Institute and John Richards Centre for Rural Ageing Research, La Trobe University, Albury-Wodonga, VIC 3086, Australia;
| | - Julia F-M. Gilmartin-Thomas
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia;
- Allied Health Department, Alfred Health, Melbourne, VIC 3181, Australia
| | - Nicholas F. Taylor
- Academic and Research Collaborative in Health, La Trobe University, Melbourne, VIC 3086, Australia; (J.P.M.); (N.F.T.); (S.L.B.); (M.E.M.)
- Eastern Health, Box Hill, VIC 3128, Australia
| | - Sharon L. Bourke
- Academic and Research Collaborative in Health, La Trobe University, Melbourne, VIC 3086, Australia; (J.P.M.); (N.F.T.); (S.L.B.); (M.E.M.)
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
| | | | - Susan Hammond
- Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Melbourne, VIC 3150, Australia;
| | - Meg E. Morris
- Academic and Research Collaborative in Health, La Trobe University, Melbourne, VIC 3086, Australia; (J.P.M.); (N.F.T.); (S.L.B.); (M.E.M.)
- Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Melbourne, VIC 3150, Australia;
| |
Collapse
|
6
|
Pountney J, Butcher I, Donnelly P, Morrison R, Shaw RL. How the COVID-19 crisis affected the well-being of nurses working in paediatric critical care: A qualitative study. Br J Health Psychol 2023; 28:914-929. [PMID: 36997476 DOI: 10.1111/bjhp.12661] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVES Evidence shows paediatric critical care (PCC) nurses display high rates of burnout, moral distress, symptoms associated with post-traumatic stress disorder (PTSD) and poor well-being. The COVID-19 pandemic magnified these pressures producing extremely challenging working conditions. The objective was to understand PCC nurses' lived experience of working during COVID-19 to determine the impact it had on their well-being. DESIGN A qualitative design was used with individual, semi-structured online interviews analysed using thematic analysis. RESULTS Ten nurses from six PCC units in England participated. Five themes were generated: (i) Challenges of working in Personal Protective Equipment (PPE), (ii) Adapting to redeployment to adult intensive care, (iii) Changes to staff working relationships, (iv) Being unable to attain work-life balance and (v) Unprocessed traumatic experiences of working in COVID-19. It was clear COVID-19 presented novel challenges to PCC nurses' well-being. With those came enforced changes in practice; some were temporary, for example use of PPE and redeployment, but others provided insight into the prerequisites for good staff well-being, for example strong professional relationships, work-life balance and managing one's psychological health. CONCLUSIONS Findings show authentic connections between peers, verbal and non-verbal communication and a sense of belonging were crucial to nurses' well-being. A dent in PCC nurses' perceived competence significantly affected their well-being. Finally, staff need a psychologically safe space to process distress and trauma experienced during COVID-19. Future research needs to test evidence-based, theoretically-informed well-being interventions to improve and maintain PCC nurses' well-being.
Collapse
Affiliation(s)
- Jackson Pountney
- Institute of Health & Neurodevelopment, College of Health & Life Sciences, Aston University, Birmingham, B4 7ET, UK
| | | | - Peter Donnelly
- Paediatric Intensive Care Unit, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Rachael Morrison
- Paediatric Intensive Care Unit, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Rachel L Shaw
- Institute of Health & Neurodevelopment, College of Health & Life Sciences, Aston University, Birmingham, B4 7ET, UK
| |
Collapse
|
7
|
Welleford EA, Watson TB, Amateau G, Johnson M. Insights and Innovation: How a Local Public-Private Partnership is Building Home Care. J Appl Gerontol 2023; 42:544-551. [PMID: 36592399 DOI: 10.1177/07334648221147915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Recent national reports asserted an urgent imperative for transforming working conditions for the direct care workforce in the US. These clarion reports identified key influencers in reform as federal and state governments, workers' unions and coalitions, individual and organizational employers. Equally essential and well-positioned local actors have been overlooked in the conversation-namely, municipalities, area agencies on aging, higher education, philanthropic entities, and community. Although deemed "essential," direct care workers have been disproportionately affected by the COVID-19 pandemic. This paper examines an early public-private partnership initiative designed to recruit and train PCAs in Virginia.
Collapse
Affiliation(s)
- E Ayn Welleford
- Department of Gerontology, 6889Virginia Commonwealth University, Richmond, VA, USA
| | - Thelma B Watson
- Senior Connections: The Capital Area Agency on Aging, Richmond, VA, USA
| | - Gigi Amateau
- Department of Gerontology, 6889Virginia Commonwealth University, Richmond, VA, USA
| | | |
Collapse
|