Ethical challenges experienced by care home staff during COVID-19 pandemic

Perceived dilemma between protective measures and social isolation in nursing homes during the COVID-19 pandemic: a mixed methods study among Swiss nursing home directors

Background

Coronavirus pandemic (COVID-19) particularly affected older adults, with the highest risks for nursing home residents. Stringent governmental protective measures for nursing homes unintendedly led to social isolation of residents. Nursing home directors (NDs) found themselves in a dilemma between implementing protective measures and preventing the social isolation of nursing home residents.

Objectives

The objectives of this study were to describe protective measures implemented, to investigate NDs' perception of social isolation and its burden for nursing home residents due to these measures, and to explore experiences of NDs in the context of the dilemma.

Methods

Cross-sectional embedded mixed-method study carried out by an online survey between April 27 and June 09, 2022, among NDs in the German-speaking part of Switzerland. The survey consisted of 84 closed-ended and nine open-ended questions. Quantitative findings were analyzed with descriptive statistics and qualitative data were evaluated using content analysis.

Results

The survey was completed by 398 NDs (62.8% female, mean age 55 [48-58] years) out of 1'044 NDs invited.NDs were highly aware of the dilemma. The measures perceived as the most troublesome were restrictions to leave rooms, wards or the home, restrictions for visitors, and reduced group activities. NDs and their teams developed a variety of strategies to cope with the dilemma, but were burdened themselves by the dilemma.

Conclusion

As NDs were burdened themselves by the responsibility of how to deal best with the dilemma between protective measures and social isolation, supportive strategies for NDs are needed.

Staff's experiences of a culturally specific DEmentia Competence Education for Nursing home Taskforce (DECENT) programme: A qualitative process evaluation

AIM

To understand participants' experiences with a culturally specific DEmentia Competence Education for Nursing home Taskforce programme within the contexts which was delivered.

DESIGN

An exploratory descriptive qualitative approach.

METHODS

Semi-structured individual interviews were conducted within one week with the participants upon their completion of the programme from July 2020 to January 2021. A purposive sample of participants with different demographic characteristics in five nursing homes was recruited to maximize the sample variation. Interviews were audiotaped and transcribed verbatim for qualitative content analysis. Participation was on voluntary and anonymous basis.

RESULTS

Four major themes were identified, including perceived benefits of the programme (i.e., enhanced sensitivity to the needs of residents with dementia, increased communication with families of residents with dementia, facilitated guidance on care for residents with dementia), facilitators (i.e., comprehensive content, active learning, qualified trainer, intrinsic motivation and organizational support), barriers (i.e., busy working schedules, discrimination against care assistants' learning capability) and suggestions for improvement.

CONCLUSION

The results suggested the acceptability of the programme. The participants positively appraised the programme in enhancing their dementia-care competence. The facilitators, barriers and suggestions identified provide insights on improving programme implementation.

IMPACT

The qualitative findings from the process evaluation are pertinent to support the sustainability of dementia competence programme in nursing home setting. Future studies could address the modifiable barriers to enhance its effectiveness.

REPORTING METHOD

This study was reported in adherence to the Consolidated criteria for reporting qualitatve studies (COREQ) checklist.

PATIENT AND PUBLIC CONTRIBUTION

Nursing-home staff was involved in intervention development and delivery.

IMPLICATIONS FOR PRACTICE/POLICY

The educational programme could be integrated into the routine practice in nursing homes to improve staff's dementia-care competence. More attention should be paid on the educational needs of the taskforce when implementing the educational programme in nursing homes. Organizational support is the precondition for the educational programme and cultivates a culture for practice change.

Registered Practical Nurses' Experiences of the Moral Habitability of Long-Term Care Environments during the COVID-19 Pandemic

The COVID-19 pandemic has had a deleterious impact on the lives of nurses who work in long-term care; however, the moral conditions of their work have been largely unexamined. The purpose of this qualitative study, therefore, was to explore registered practical nurses' (RPNs) experiences of the moral habitability of long-term care environments in Ontario, Canada during the COVID-19 pandemic. Four themes were identified: (1) Striving to meet responsibilities in a failed system; (2) bearing the moral and emotional weight of residents' isolation and dying in a context of strict public health measures; (3) knowing the realities of the work, yet failing to be heard, recognized, or supported by management; and (4) struggling to find a means of preservation for themselves and the profession. Attention to the moral habitability of RPNs' work environments is necessary to achieve a high-quality, ethically attuned, and sustainable nursing workforce in long-term care.