Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA.
Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA.
J Am Med Dir Assoc. 2024 Sep;25(9):105145. doi: 10.1016/j.jamda.2024.105145. Epub 2024 Jul 8.
Nursing home (NH) leaders remain challenged to deliver quality care, despite the COVID-19 transition to an endemic phase. This study describes NH leadership perspectives on preparing and maintaining quality care during times of diminishing resources as experienced through the COVID-19 pandemic to gain insight on how best to support NHs moving forward.
This was a cross-sectional, parallel convergent mixed methods study.
This study reports quantitative data from N = 5001 NHs across 12 states along with qualitative data from a subsample of NH leaders (N = 15).
Publicly reported survey data were analyzed using descriptive statistics. Individual in-depth interviews with NH leaders conducted at 12-month follow-up were analyzed using inductive thematic coding organized by a guiding framework. Data were integrated using convergent analysis and a joint display.
NH leaders (licensed administrators, clinical directors, and managers) reported resident and staff infection rates, and access to resources (such as personal protective equipment and testing supplies) that aligned with national trends. Leaders described their NHs (n = 14; 43% rural; 71% not for profit) to be in varied states of operational readiness (standard, contingency, crisis) to support quality infection prevention and control (IPC) at the transition to the endemic COVID-19 phase. Leadership reported continued challenges in addressing resident and staff vaccinations, securing testing supplies, obtaining financial resources to maintain acceptable levels of personal protective equipment, continued staffing shortages, and issues in implementing isolation practices in current facilities.
NH leaders continue to struggle delivering quality IPC care post-pandemic and require focused support in several areas. Clinical practice guidelines should include IPC practices to prevent the infection and spread of any COVID-19 variant in this endemic phase. Policies should support continued reporting of IPC-related metrics and adequate funding to account for the long-term financial burden NHs face.
尽管 COVID-19 已过渡到流行阶段，但养老院（NH）领导人仍面临提供高质量护理的挑战。本研究描述了 NH 领导人在 COVID-19 大流行期间资源减少的情况下，为准备和维持高质量护理的观点，以深入了解如何最好地为 NH 提供支持。
这是一项横断面、平行收敛混合方法研究。
本研究报告了来自 12 个州的 5001 家 NH 的定量数据，以及 NH 领导人的定性数据（N = 15）。
使用描述性统计分析对公开报告的调查数据进行分析。对 12 个月随访时进行的 NH 领导人的个人深入访谈使用归纳主题编码进行分析，该编码组织在指导框架下进行。使用收敛分析和联合展示对数据进行整合。
NH 领导人（持牌管理员、临床主任和经理）报告了居民和员工的感染率，以及资源（如个人防护设备和检测用品）的获取情况，这些情况与全国趋势相符。领导人描述了他们的 NH（n = 14；43%为农村；71%为非营利性）处于不同的运营准备状态（标准、应急、危机），以支持向 COVID-19 流行阶段过渡期间的高质量感染预防和控制（IPC）。领导报告在解决居民和员工疫苗接种、确保检测用品供应、获得维持可接受个人防护设备水平的财政资源、持续的人员短缺以及在现有设施中实施隔离实践方面继续面临挑战。
NH 领导人在大流行后继续努力提供高质量的 IPC 护理，在几个领域需要得到重点支持。临床实践指南应包括 IPC 实践，以防止任何 COVID-19 变异在流行阶段的感染和传播。政策应支持继续报告 IPC 相关指标，并提供充足资金，以应对 NH 面临的长期财务负担。
