Home health care professionals’ experiences of working in integrated teams during the COVID-19 pandemic: a qualitative thematic study

Abstract

Background Since COVID-19 emerged, over 514 million COVID-19 cases and 6 million COVID-19-related deaths have been reported worldwide. Older persons receiving home health care often have co-morbidities that require advanced medical care, and are at risk of becoming severely ill or dying from COVID-19. In Sweden, over 10,000 COVID-19-related deaths have been reported among persons receiving municipal home health and social care. Home health care professionals have been working with the patients most at risk if infected. Most research has focused on the experiences of professionals in hospitals and assistant nurses in a home care setting. It is therefore valuable to study the experiences of the registered nurses and physicians working in home health care during the COVID-19 pandemic to learn lessons to inform future work. Method A thematic qualitative study design using a semi-structured interview guide. Results The health care professionals experienced being forced into changed ways of working, which disrupted building and maintaining relationships with other health care professionals, and interrupted home health care. The health care professionals described being forced into digital and phone communication instead of in-person meetings, which negatively influenced the quality of care. The COVID-19 pandemic brought worry about illness for the health care professionals, including worrying about infecting patients, co-workers, and themselves, as well as worry about upholding the provision of health care because of increasing sick leave. The health care professionals felt powerless in the face of their patients’ declining health. They also faced worry and guilt from the patients’ next of kin. Conclusion Home health care professionals have faced the COVID-19 pandemic while working across organizational borders, caring for older patients who have been isolated during the pandemic and trying to prevent declining health and feelings of isolation. Due to the forced use of digital and phone communication instead of in-person visits, the home health care professionals experienced a reduction in the patients’ quality of care and difficulty maintaining good communication between the professions.

“Returning to the core tasks”: a qualitative interview study about how general practitioners in home health care solved problems during the COVID-19 pandemic

“…Participating GPs demonstrated self-confidence and exhibited willingness to surpass established guidelines. However, other studies have reported that physicians in the COVID-19 crisis felt restricted by guidelines that recommended them to evaluate patients at a distance and to avoid direct patient contact [ 29 , 30 ]. Likewise, primary care physicians have described stress due to ethical dilemmas [ 15 ].…”

“…Similarly, Swedish nurses working in infectious disease wards described feelings of pride and meaningfulness when caring for COVID-19 patients, as there was a shift from administrative duties to patient-centered care facilitated by supportive leadership and well-functioning teams [ 42 ]. In contrast, nurses working in mobile integrated care teams in Sweden described a breakdown in teamwork during the pandemic as they mainly performed home visits by themselves, and physicians became invisible in care, making nurses feel forced to shift from person-centered to need-oriented care [ 30 ]. Others report that during the pandemic, physicians in primary care [ 43 ] and nursing homes [ 17 ] were absent from the team and worked remotely, leading to nurses and other care workers feeling they had to take on greater responsibility.…”

“…In the context of our study, there was usually robust teamwork between physicians and nurses in HHC prior to the pandemic. We did not interview registered nurses in HHC who may have experienced teamwork differently; and in other contexts nurses reported feeling left alone by physicians during the pandemic and expressed that they had to bear the heaviest burden [ 29 , 30 ]. Effective teamwork is an essential component of high-quality and efficient primary care delivery [ 29 ].…”