Reflections from the “Forgotten Front Line”: A qualitative study of factors affecting wellbeing among long-term care workers in New York City during the COVID-19 pandemic

Fisher, Elisa; Cárdenas, Luisa; Kieffer, Elana F; Larson, Elaine

doi:10.1016/j.gerinurse.2021.09.002

Cited by 30 publications

(25 citation statements)

References 19 publications

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“…For example, psychological services have been provided, including assistance hotlines and around‐the‐clock online counseling services (Liu et al, 2020 ) and other services, such as educational training sessions, mental health services, and advocacy for provision of emotional and practical support (e.g., childcare, and access to showers and lodging) (Miotto et al, 2020 ). In contrast, none of our respondents mentioned receipt of these kinds of staff support, similar to what Fisher et al ( 2021 ) have reported. The lack of these types of staff support in Israel likely contributed to the negative psychological effects of COVID‐19 on staff.…”

Section: Discussionsupporting

confidence: 89%

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The impact of COVID‐19 on long‐term care facilities and their staff in Israel: Results from a mixed methods study

Cohen‐Mansfield

2022

J Nursing Management

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Aim We examined the impact of COVID‐19 regarding organizational and management issues at Israeli long‐term care facilities. Background Residents in facilities were very vulnerable to significant disease and mortality during COVID‐19. Methods A survey of 52 facilities in Israel was conducted in 2020, consisting of closed‐ and open‐ended questions. Mixed methods were used to analyze data both quantitatively and qualitatively. Results Three main effects emerged: worsened financial status of long‐term‐care facilities resulting from high expenditures for preventive measures and reduced revenue due to deaths and fewer resident admissions, increased workload due to decreased workforce and additional duties, and negative mental health effects on staff because of increased workload and the conflict between maintaining good clinical practice and following COVID‐19 regulations. Conclusion The development of government directives needs to take into account potential conflicts between the directives and quality care principles and to provide a balanced approach that assures humane care. Facilities and their staff lacked adequate pandemic‐related guidance and support. Implications for Nursing Management The results highlight the need to address staff shortages and training, to provide more support and clearer guidance to facilities and their staff, and to devise a framework and strategies for future health crises.

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Section: Discussionsupporting

confidence: 89%

“…Staff shortages resulted in double and longer shifts and required staff to perform tasks beyond the scope of their previous duties or skill set. A study conducted in New York City also reported increased workload and short‐staffing issues that arose after the onset of the pandemic (Fisher et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

The impact of COVID‐19 on long‐term care facilities and their staff in Israel: Results from a mixed methods study

Cohen‐Mansfield

2022

J Nursing Management

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“…Concerning the qualitative experiences of LTCWs overall, our findings that they feel underappreciated professionally are consistent with the findings in the literature, including research that has emerged during the COVID-19 pandemic [43]. Fisher et al memorably called LTCWs the "forgotten front line" [43]. Other researchers reported that LTCWs felt invisible and unsupported [44].…”

Section: Comparison With Prior Worksupporting

confidence: 87%

Co-Development of a Web Application (COVID-19 Social Site) for Long-Term Care Workers (“Something for Us”): User-Centered Design and Participatory Research Study

et al. 2022

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Background Improving confidence in and uptake of COVID-19 vaccines and boosters among long-term care workers (LTCWs) is a crucial public health goal, given their role in the care of elderly people and people at risk. While difficult to reach with workplace communication interventions, most LTCWs regularly use social media and smartphones. Various social media interventions have improved attitudes and uptake for other vaccines and hold promise for the LTCW population. Objective We aimed to develop a curated social web application (interactive website) to increase COVID-19 vaccine confidence (a 3-arm randomized trial is underway). Methods Following user-centric design and participatory research approaches, we undertook the following 3 steps: (1) content identification, (2) platform development, and (3) community building. A LTCW and stakeholder advisory group provided iterative input. For content identification (step 1), we identified topics of concern about COVID-19 vaccines via desktop research (published literature, public opinion polls, and social media monitoring), refined by interviewing and polling LTCWs. We also conducted a national online panel survey. We curated and fact-checked posts from popular social media platforms that addressed the identified concerns. During platform development (step 2), we solicited preferences for design and functionality via interviews and user experience testing with LTCWs. We also identified best practices for online community building (step 3). Results In the interviews (n=9), we identified 3 themes: (1) LTCWs are proud of their work but feel undervalued; (2) LTCWs have varying levels of trust in COVID-19–related information; and (3) LTCWs would welcome a curated COVID-19 resource that is easy to understand and use-"something for us". Through desktop research, LTCW interviews, and our national online panel survey (n=592) we found that participants are interested in information about COVID-19 in general, vaccine benefits, vaccine risks, and vaccine development. Content identification resulted in 434 posts addressing these topic areas, with 209 uploaded to the final web application. Our LTCW poll (n=8) revealed preferences for personal stories and video content. The platform we developed is an accessible WordPress-based social media web application, refined through formal (n=3) and informal user experience testing. Users can sort posts by topic or subtopic and react to or comment on posts. To build an online community, we recruited 3 LTCW “community ambassadors” and instructed them to encourage discussion, acknowledge concerns, and offer factual information on COVID-19 vaccines. We also set “community standards” for the web application. Conclusions An iterative, user-centric, participatory approach led to the launch of an accessible social media web application with curated content for COVID-19 vaccines targeting LTCWs in the United States. Through our trial, we will determine if this approach successfully improves vaccine confidence. If so, a similar social media resource could be used to develop curated social media interventions in other populations and with other public health goals.

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“…The COVID-19 pandemic placed heavy pressure on healthcare systems, resulting in excessive job demands and tumultuous work environments. Increases in workload were widely found to be positively correlated with turnover intention among HCWs [ 38 , 45 , 55 , 56 ]. In addition, HCWs who worked long hours, or faced an increase in working hours due to the pandemic, were more prone to experiencing turnover intention [ 40 , 50 , 55 , 59 ].…”

Section: Resultsmentioning

confidence: 99%

A global overview of healthcare workers’ turnover intention amid COVID-19 pandemic: a systematic review with future directions

et al. 2022

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Background Globally, the health workforce has long suffered from labour shortages. This has been exacerbated by the workload increase caused by the COVID-19 pandemic. Major collapses in healthcare systems across the world during the peak of the pandemic led to calls for strategies to alleviate the increasing job attrition problem within the healthcare sector. This turnover may worsen given the overwhelming pressures experienced by the health workforce during the pandemic, and proactive measures should be taken to retain healthcare workers. This review aims to examine the factors affecting turnover intention among healthcare workers during the COVID-19 pandemic. Methods A mixed studies systematic review was conducted. The PubMed, Embase, Scopus, CINAHL, Web of Science and PsycINFO databases were searched from January 2020 to March 2022. The Joanna Briggs Institute’s Critical Appraisal Tools and the Mixed Methods Appraisal Tool version 2018 were applied by two independent researchers to critically appraise the methodological quality. Findings were synthesised using a convergent integrated approach and categorised thematically. Results Forty-three studies, including 39 quantitative, two qualitative and two mixed methods studies were included in this review. Eighteen were conducted in the Middle East, ten in the Americas, nine in the Asia–Pacific region and six in Europe. Nurses (n = 35) were included in the majority of the studies, while physicians (n = 13), allied health workers (n = 11) and healthcare administrative or management staff (n = 7) were included in a smaller proportion. Five themes emerged from the data synthesis: (1) fear of COVID-19 exposure, (2) psychological responses to stress, (3) socio-demographic characteristics, (4) adverse working conditions, and (5) organisational support. Conclusions A wide range of factors influence healthcare workers’ turnover intention in times of pandemic. Future research should be more focused on specific factors, such as working conditions or burnout, and specific vulnerable groups, including migrant healthcare workers and healthcare profession minorities, to aid policymakers in adopting strategies to support and incentivise them to retain them in their healthcare jobs.

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Reflections from the “Forgotten Front Line”: A qualitative study of factors affecting wellbeing among long-term care workers in New York City during the COVID-19 pandemic

Cited by 30 publications

References 19 publications

The impact of COVID‐19 on long‐term care facilities and their staff in Israel: Results from a mixed methods study

The impact of COVID‐19 on long‐term care facilities and their staff in Israel: Results from a mixed methods study

Co-Development of a Web Application (COVID-19 Social Site) for Long-Term Care Workers (“Something for Us”): User-Centered Design and Participatory Research Study

A global overview of healthcare workers’ turnover intention amid COVID-19 pandemic: a systematic review with future directions

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