What Kind of Interventions Were Perceived as Effective Against Coronavirus-19 in Nursing Homes in Italy? A Descriptive Qualitative Study

Abstract

Purpose To identify interventions implemented during the first, second and third waves of the Coronavirus disease 2019 (COVID-19) among Italian Nursing Homes (NHs). Patients and Methods A descriptive qualitative design according to COnsolidated criteria for REporting Qualitative (COREQ) guideline. A purposeful sample of five public NHs, located in the north-east of Italy, equipped with from 60 to 151 beds, participated. Six nurse managers, four clinical nurses and one NH director were interviewed in depth at the end of 2021. These interviews were audio-recorded and then transcribed verbatim. A qualitative content analysis was performed to identify effective interventions as perceived by participants to protect facilities and residents from the pandemic. Results Three main sets of interventions have been applied, at the environmental, nurse staff and at the resident levels. Some have been enacted in all facilities, others in a few but in a homogeneous fashion, while other interventions have been implemented in some NHs also in contrast with available national or local recommendations. Conclusion Despite their documented frailty and precarious system, NHs implemented several interventions to protect their residents from the COVID-19. All interventions have been designed and implemented during the event, suggesting the need to increase the NHs’ preparedness to face future disasters. Regarding those interventions enacted in contrast to the recommendations or not homogeneously across NHs, future investigations are suggested to assess their actual effectiveness and accumulate evidence for the future.

Health and care workers in long‐term care facilities and their role in preventing emerging infectious diseases: A scoping review

“…It will also ensure that the policies and plans developed are aligned with the needs of care-home settings. A study by Palese et al (2022) found that nursing home staff had to make decisions and rely on policies that have a limited evidence-base because the policies and guidelines created by regulatory bodies during the pandemic were often generic and not tailored for nursing homes, which meant they had to interpret them on their own and adapt them to local needs, and justify their decisions to regulatory bodies when one guideline or policy was favored over another.…”

Care‐home Nurses' responses to the COVID‐19 pandemic: Managing ethical conundrums at personal cost: A qualitative study

“…Nurses in our study reported all these issues, identifying that their ability to provide high-quality, personalized care at the micro level was impacted by decisions made at meso and macro levels, over which they had no or little power, thus feeling disempowered by the process. Further, care-home RNs found themselves making decisions and relying on guidance that had a limited evidence-base (Palese et al, 2022).…”

“…Nurses in our study reported all these issues, identifying that their ability to provide high‐quality, personalized care at the micro level was impacted by decisions made at meso and macro levels, over which they had no or little power, thus feeling disempowered by the process. Further, care‐home RNs found themselves making decisions and relying on guidance that had a limited evidence‐base (Palese et al, 2022). Regulatory bodies created policies and guidelines, often generic rather than care‐home specific, and not always aligned with each other, so care‐home staff had to interpret and apply to local need, and justify decision‐making to regulatory bodies when one guideline or policy was favored over another.…”

“…These issues are global, so it is not surprising that the arrival of the COVID‐19 pandemic in 2020, which brought with it a new set of pressures, compounding the existing ones, had such a devastating effect in care‐homes and on its workforce (Langins et al, 2020), creating an international public health emergency (Fernandez et al, 2020; Ibrahim & Aitken, 2021). Apart from a few exemplars (such as Hong Kong and New Zealand), most countries failed to adequately protect their nursing home populations, exemplified in severe cases in countries such as Italy (Bilal et al, 2020; Brady et al, 2021; Calcaterra et al, 2022; Ibrahim & Aitken, 2021; Langins et al, 2020; Palese et al, 2022; Rocard et al, 2021; Sarabia‐Cobo et al, 2021). Care‐homes for older adults were disproportionately affected by the pandemic with increased resident mortality and staff distress (Langins et al, 2020; Palese et al, 2022; Rocard et al, 2021).…”

“…Apart from a few exemplars (such as Hong Kong and New Zealand), most countries failed to adequately protect their nursing home populations, exemplified in severe cases in countries such as Italy (Bilal et al, 2020; Brady et al, 2021; Calcaterra et al, 2022; Ibrahim & Aitken, 2021; Langins et al, 2020; Palese et al, 2022; Rocard et al, 2021; Sarabia‐Cobo et al, 2021). Care‐homes for older adults were disproportionately affected by the pandemic with increased resident mortality and staff distress (Langins et al, 2020; Palese et al, 2022; Rocard et al, 2021). Typically accounting for less than 1% of the population, residents of long‐term care facilities represented 41% of all COVID‐19 related deaths in 22 high‐income countries by January 2021 (mid‐pandemic) (Comas‐Herrera et al, 2020).…”