How to bring residents’ psychosocial well-being to the heart of the fight against Covid-19 in Belgian nursing homes—A qualitative study

Abstract

Background Nursing homes (NH) for the elderly have been particularly affected by the Covid-19 pandemic mainly due to their hosted vulnerable populations and poor outbreak preparedness. In Belgium, the medical humanitarian organization Médecins Sans Frontières (MSF) implemented a support project for NH including training on infection prevention and control (IPC), (re)-organization of care, and psychosocial support for NH staff. As psychosocial and mental health needs of NH residents in times of Covid-19 are poorly understood and addressed, this study aimed to better understand these needs and how staff could respond accordingly. Methods A qualitative study adopting thematic content analysis. Eight focus group discussions with direct caring staff and 56 in-depth interviews with residents were conducted in eight purposively and conveniently selected NHs in Brussels, Belgium, June 2020. Results NH residents experienced losses of freedom, social life, autonomy, and recreational activities that deprived them of their basic psychological needs. This had a massive impact on their mental well-being expressed in feeling depressed, anxious, and frustrated as well as decreased meaning and quality of life. Staff felt unprepared for the challenges posed by the pandemic; lacking guidelines, personal protective equipment and clarity around organization of care. They were confronted with professional and ethical dilemmas, feeling ‘trapped’ between IPC and the residents’ wellbeing. They witnessed the detrimental effects of the measures imposed on their residents. Conclusion This study revealed the insights of residents’ and NH staff at the height of the early Covid-19 pandemic. Clearer outbreak plans, including psychosocial support, could have prevented the aggravated mental health conditions of both residents and staff. A holistic approach is needed in NHs in which tailor-made essential restrictive IPC measures are combined with psychosocial support measures to reduce the impact on residents’ mental health impact and to enhance their quality of life.

Psychosocial burden and associated factors among nurses in care homes during the COVID-19 pandemic: findings from a retrospective survey in Germany

“…Besides, our ndings showed that COVID-19-related burden at work (e.g., lack of personal protection equipment, a small number of COVID-19-Tests for residents and staff) was positively associated with the dissatisfaction with COVID-19 management of care home management, COVID-19-related anxiety, and dementia as a focus of care. This is in line with previous research showing that there was uncertainty about implemented hygiene measures due to a lack of communication and information and not being included in decision-making processes by care home management during the pandemic [8, 31,32,33]. A higher burden for care home staff working with residents with dementia, in general, was a concern even Loading [MathJax]/jax/output/CommonHTML/fonts/TeX/fontdata.js before the pandemic [34].…”

“…Prior research showed that care home staff often did not feel involved in decision-making processes and did not feel heard by the management of their care homes. A lack of communication between management and staff caused uncertainty and distress about handling the pandemic and implementing measures to prevent infections [31,32,33].…”

The effects of fear of COVID-19, loneliness, and resilience on the quality of life in older adults living in a nursing home

“…Similar to the results obtained from the present study, one study reported that the mean BRS score was 19.41±2.67 in individuals over the age of 65 during the COVID-19 process. 19 Psychological resilience refers to an individual's ability to successfully overcome adverse conditions and adapt to a new situation. 36 While loneliness, negative feelings, and mental illness negatively affect resilience, 45 , 49 , 50 well-being, social networking, and positive feelings positively affect resilience.…”

“… 9 , 17 The restrictive measures, fear, and loneliness could adversely affect the physical, psychological, mental health, life style, and quality of life (QOL) of older adults. 5 , 17 , 18 , 19 , 20 …”

COVID-19 in French Nursing Homes during the Second Pandemic Wave: A Mixed-Methods Cross-Sectional Study

“…Yet, the medical and staffing needs of residents were simultaneously surging, forcing many sick (and infectious) caregivers back into the workplace. The cycle was compounded by the destructive effects that an enormous workload and an anxiety-producing work environment is known to have on caregivers' wellbeing [12,18,20,21,36].…”