Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Health Soc Care Deliv Res. 2024 Nov;12(45):1-164. doi: 10.3310/YNTW4569.
Older people living in care homes are at high risk of poor health outcomes and mortality if they contract coronavirus disease 2019. Protective measures include social distancing and isolation, although implementation is challenging.
To explore the real-life experiences of social distancing and isolation in care homes for older people, and to develop a toolkit of guidance and resources.
A mixed-methods, phased design.
Six care homes in England caring for older adults.
Care home staff ( = 31), residents ( = 17), family members ( = 17), senior health and care leaders ( = 13).
A rapid review to assess the social distancing and isolation measures used by care homes to control the transmission of coronavirus disease 2019 and other infectious diseases (phase 1), in-depth case studies of six care homes, involving remote individual interviews with staff, residents and families, collection of policies, protocols and routinely collected care home data, remote focus groups with senior health and care leaders (phase 2) and stakeholder workshops to co-design the toolkit (phase 3). Interview and focus group data and care home documents were analysed using thematic analysis and care home data using descriptive statistics.
The rapid review of 103 records demonstrated limited empirical evidence and the limited nature of policy documentation around social distancing and isolation measures in care homes. The case studies found that social distancing and isolation measures presented moral dilemmas for staff and often were difficult, and sometimes impossible to implement. Social distancing and isolation measures made care homes feel like an institution and denied residents, staff and families of physical touch and other forms of non-verbal communication. This was particularly important for residents with cognitive impairment. Care homes developed new visiting modalities to work around social distancing measures. Residents and families valued the work of care homes to keep residents safe and support remote communication. Social distancing, isolation and related restrictions negatively impacted on residents' physical, psychological, social and cognitive well-being. There were feelings of powerlessness for families whose loved ones had moved into the care home during the pandemic. It was challenging for care homes to capture frequent updates in policy and guidance. Senior health and care leaders shared that the care home sector felt isolated from the National Health Service, communication from government was described as chaotic, and trauma was inflicted on care home staff, residents, families and friends. These multiple data sources have informed the co-design of a toolkit to care for residents, families, friends and care home staff.
The review included papers published in English language only. The six care homes had a Care Quality Commission rating of either 'good' or 'outstanding'. There was a lack of ethnic diversity in resident and family participants.
Care homes implemented innovative approaches to social distancing and isolation with varying degrees of success. A legacy of learning can help rebuild trust at multiple levels and address trauma-informed care for residents, families, friends and staff. Future work can include evaluation of the toolkit, research to develop a trauma-informed approach to caring for the care home sector and co-designing and evaluating an intervention to enable residents with different needs to transition to living well in a care home.
This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132541) and is published in full in ; Vol. 12, No. 45. See the NIHR Funding and Awards website for further award information.
在感染 2019 年冠状病毒病（COVID-19）的情况下，居住在养老院的老年人如果出现健康状况不佳和死亡，风险很高。保护措施包括保持社交距离和隔离，尽管实施起来具有挑战性。
探索养老院中老年人保持社交距离和隔离的实际经验，并开发一套指导和资源工具包。
混合方法、分阶段设计。
英格兰的六家养老院，为老年人提供护理。
养老院工作人员（=31 人）、居民（=17 人）、家属（=17 人）、高级卫生和保健领导人（=13 人）。
快速审查评估养老院控制 2019 年冠状病毒病和其他传染病传播所采用的保持社交距离和隔离措施（第 1 阶段），对六家养老院进行深入案例研究，包括对工作人员、居民和家属进行远程个别访谈、收集政策、协议和常规收集的养老院数据、与高级卫生和保健领导人进行远程焦点小组讨论（第 2 阶段）以及利益相关者研讨会共同设计工具包（第 3 阶段）。使用主题分析对访谈和焦点小组数据以及养老院文件进行分析，使用描述性统计对养老院数据进行分析。
对 103 份记录的快速审查表明，有关养老院保持社交距离和隔离措施的经验证据有限，政策文件的范围有限。案例研究发现，保持社交距离和隔离措施给工作人员带来了道德困境，而且往往难以实施，有时甚至无法实施。保持社交距离和隔离措施使养老院感觉像一个机构，剥夺了居民、工作人员和家属身体接触和其他形式的非言语交流的机会。这对有认知障碍的居民尤为重要。养老院开发了新的探视模式，以绕过保持社交距离的措施。居民和家属对养老院为保护居民安全和支持远程沟通所做的工作表示赞赏。保持社交距离、隔离和相关限制对居民的身心健康产生了负面影响。在大流行期间将亲人转移到养老院的家属感到无能为力。养老院难以及时获取政策和指导的频繁更新。高级卫生和保健领导人表示，养老院部门感到与国家卫生服务局隔离，政府的沟通描述为混乱，并且对养老院工作人员、居民、家属和朋友造成了创伤。这些多源数据为共同设计一套关怀居民、家属、朋友和养老院工作人员的工具包提供了信息。
该审查包括仅发表在英文文献中的论文。六家养老院的护理质量委员会评级均为“良好”或“优秀”。居民和家属参与者缺乏种族多样性。
养老院实施了创新的保持社交距离和隔离措施，取得了不同程度的成功。经验教训可以帮助在多个层面重建信任，并解决以创伤知情的方式为居民、家属、朋友和工作人员提供护理的问题。未来的工作可以包括对工具包的评估、开发以创伤知情的方式为养老院部门提供护理的研究以及共同设计和评估使有不同需求的居民能够顺利过渡到在养老院生活的干预措施。
该奖项由英国国家卫生研究院（NIHR）健康和社会保健交付研究计划（NIHR 奖 REF：NIHR132541）资助，并在 ; 第 12 卷，第 45 期全文发表。有关该奖项的更多信息，请访问 NIHR 资助和奖项网站。
