Psychosocial burden in nurses working in nursing homes during the Covid-19 pandemic: a cross-sectional study with quantitative and qualitative data

Abstract

Background The Covid-19 pandemic led to increased work-related strain and psychosocial burden in nurses worldwide, resulting in high prevalences of mental health problems. Nurses in long-term care facilities seem to be especially affected by the pandemic. Nevertheless, there are few findings indicating possible positive changes for health care workers. Therefore, we investigated which psychosocial burdens and potential positive aspects nurses working in long-term care facilities experience during the Covid-19 pandemic. Methods We conducted a mixed-methods study among nurses and nursing assistants working in nursing homes in Germany. The survey contained the third German version of the Copenhagen Psychosocial Questionnaire (COPSOQ III). Using Welch’s t-tests, we compared the COPSOQ results of our sample against a pre-pandemic reference group of geriatric nurses from Germany. Additionally, we conducted semi-structured interviews with geriatric nurses with a special focus on psychosocial stress, to reach a deeper understanding of their experiences on work-related changes and burdens during the pandemic. Data were analysed using thematic coding (Braun and Clarke). Results Our survey sample (n = 177) differed significantly from the pre-pandemic reference group in 14 out of 31 COPSOQ scales. Almost all of these differences indicated negative changes. Our sample scored significantly worse regarding the scales ‘quantitative demands’, ‘hiding emotions’, ‘work-privacy conflicts’, ‘role conflicts’, ‘quality of leadership’, ‘support at work’, ‘recognition’, ‘physical demands’, ‘intention to leave profession’, ‘burnout’, ‘presenteeism’ and ‘inability to relax’. The interviews (n = 15) revealed six main themes related to nurses’ psychosocial stress: ‘overall working conditions’, ‘concern for residents’, ‘management of relatives’, ‘inability to provide terminal care‘, ‘tensions between being infected and infecting others’ and ‘technicisation of care’. ‘Enhanced community cohesion’ (interviews), ‘meaning of work’ and ‘quantity of social relations’ (COPSOQ III) were identified as positive effects of the pandemic. Conclusions Results clearly illustrate an aggravation of geriatric nurses’ situation and psychosocial burden and only few positive changes due to the Covid-19 pandemic. Pre-existing hardships seem to have further deteriorated and new stressors added to nurses’ strain. The perceived erosion of care, due to an overemphasis of the technical in relation to the social and emotional dimensions of care, seems to be especially burdensome to geriatric nurses.

Moral failure, moral prudence, and character challenges in residential care during the Covid-19 pandemic

“…Especially nurses in residential care witnessed the impact of social isolation on many residents, trying to compensate the loss of social connection, among others, by the use of social media. 29,33 Against this background, it is difficult—if not presumptuous—to identify at what point, one can speak of a moral failure at an individual level. Additionally, the “heroization” of nurses and other healthcare professionals in the pandemic can be assumed to have complicated the focus on issues of moral agency in the light of exacerbated resident vulnerability and intergenerational social justice.…”

“…Health professionals were often the only ones who had ongoing access to residents and knew the impact of visiting bans on resident's physical and mental health, 2,4,7 but they did not necessarily consider themselves as moral agents entitled to address or question the practice of shielding, even though they experienced first line its deleterious effects. 29,33,51 Regarding the ethical evaluation of this practice and its reference to moral character, Geoff Moore's account of Alasdair MacIntyre's virtue framework 52,53 for the context of professional practice is clarifying: First, it basically contends that "practice" has to be considered a morally thick term insofar-in MacIntyre's sense-it inherently produces morally valuable goods and agents have therefore to meet the requirements of moral character. Consequently, there cannot be such thing as a space of practice outside of moral agency.…”

“…26,27,28 As an immediate consequence, also phenomena of stigmatization of healthcare workers could be observed. 29 Importantly, both forms of vulnerability must be understood as expressions of the practice of shielding, with the second, "reverse" form being better able to explain the "great silence" mentioned above.…”

Day to Day and Environmental Risk Factors for Psychological Distress Among Healthcare Workers

“…For example, multiple studies with nurses have integrated qualitative and quantitative data to investigate how fear and uncertainty, moral injury, isolation, and workplace conditions could explain declining mental health during the pandemic. [11][12][13] Another mixed-methods study among nurses highlighted the importance of organizational factors over individual resilience in shaping traumatic stress, 14 and a study among nurses and physicians underscored the role of autonomy (or its loss) in shaping anxiety and depression. 15 While these studies provide important insight into the nuanced factors shaping distress for clinical staff, there are still gaps in the literature regarding the lived experiences of service and nonclinical staff…”

“…However, few studies of mental distress among HHWs during COVID-19 have applied fully integrated mixed-methods designs among both nonclinical and clinical staff. For example, multiple studies with nurses have integrated qualitative and quantitative data to investigate how fear and uncertainty, moral injury, isolation, and workplace conditions could explain declining mental health during the pandemic 11–13 . Another mixed-methods study among nurses highlighted the importance of organizational factors over individual resilience in shaping traumatic stress, 14 and a study among nurses and physicians underscored the role of autonomy (or its loss) in shaping anxiety and depression 15 .…”