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Wilpstra CD, Morrell S, Mirza NA, Ralph JL. Consequences of COVID-19 Vaccine Hesitancy Among Healthcare Providers During the First 10 Months of Vaccine Availability: Scoping Review. Can J Nurs Res 2024:8445621241251711. [PMID: 38693882 DOI: 10.1177/08445621241251711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Throughout the COVID-19 pandemic, healthcare providers (HCPs)-including nurses-have played important roles in the vaccination effort. It is expected that COVID-19 vaccine hesitancy among HCPs has numerous consequences; however, the scope of these consequences and their impacts on providers, patients, and the broader healthcare system remained unclear. PURPOSE To identify existing and emerging evidence to understand the state of knowledge of the consequences of COVID-19 vaccine hesitancy among HCPs. METHODS A scoping review was completed based upon the JBI scoping review methodology. The databases searched included OVID Medline, EBSCOhost CINAHL, ProQuest Nursing and Allied Health Source, ProQuest APA PsycInfo, and ProQuest Dissertations and Theses. The final literature search was completed on June 2, 2022. Studies were screened and retrieved based on predefined inclusion and exclusion criteria using Covidence reference management software. Data extraction followed criteria recommended in the JBI scoping review framework with additional relevant variables identified by the authors. RESULTS A total of 33 sources were included in the review. Consequences of HCP COVID-19 vaccine hesitancy were grouped under three themes and seven subthemes. Consequences affecting HCPs included health-related, psychosocial, and employment-related consequences. Consequences affecting patients pertained to COVID-19 vaccination communication and COVID-19 vaccination practices of HCPs. Consequences to the healthcare system involved consequences to coworkers and employment/attendance/staffing-related consequences. CONCLUSIONS Healthcare provider COVID-19 vaccine hesitancy was found to have numerous consequences. By understanding the scope and extent of these consequences, healthcare leaders, researchers, and HCPs can work together to protect providers, patients, and healthcare systems.
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Affiliation(s)
| | - Sherry Morrell
- Faculty of Nursing, University of Windsor, Windsor, Canada
| | - Noeman A Mirza
- Faculty of Nursing, University of Windsor, Windsor, Canada
| | - Jody L Ralph
- Faculty of Nursing, University of Windsor, Windsor, Canada
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Pettingell SL, Bershadsky J, Hewitt A, Anderson LL, Zhang A. Direct Support Professionals and COVID-19 Vaccination: A Comparison of Vaccinated Early Adopters and In-Betweeners. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2023; 61:492-505. [PMID: 38011745 PMCID: PMC10896219 DOI: 10.1352/1934-9556-61.6.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/03/2023] [Indexed: 11/29/2023]
Abstract
Direct support professionals (DSPs) are at increased risk of contracting COVID-19. A four-wave survey series was conducted, in part, to understand DSPs' COVID-19 vaccination experiences. Fourth wave data were used to compare those vaccinated against COVID-19 when they became eligible (early adopters) and those waiting at least three months before vaccination (in-betweeners). Findings indicated that in-betweeners were more likely to be female, younger, and people of color with lower education levels and annual incomes, with employers requiring COVID-19 vaccination to remain employed. COVID-19 vaccination motivators included protection for self, family, or people supported; an employer who mandated COVID-19 vaccination; and having had COVID-19 or knowing someone who did.
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Affiliation(s)
- Sandra L Pettingell
- Sandra L. Pettingell, Julie Bershadsky, Amy Hewitt, Lynda Lahti Anderson, and Alicia Zhang, University of Minnesota
| | - Julie Bershadsky
- Sandra L. Pettingell, Julie Bershadsky, Amy Hewitt, Lynda Lahti Anderson, and Alicia Zhang, University of Minnesota
| | - Amy Hewitt
- Sandra L. Pettingell, Julie Bershadsky, Amy Hewitt, Lynda Lahti Anderson, and Alicia Zhang, University of Minnesota
| | - Lynda Lahti Anderson
- Sandra L. Pettingell, Julie Bershadsky, Amy Hewitt, Lynda Lahti Anderson, and Alicia Zhang, University of Minnesota
| | - Alicia Zhang
- Sandra L. Pettingell, Julie Bershadsky, Amy Hewitt, Lynda Lahti Anderson, and Alicia Zhang, University of Minnesota
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Golos AM, Buttenheim AM, Ritter AZ, Bair EF, Chapman GB. Effects Of An Employee COVID-19 Vaccination Mandate At A Long-Term Care Network. Health Aff (Millwood) 2023; 42:1140-1146. [PMID: 37549332 DOI: 10.1377/hlthaff.2022.01596] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
We assessed COVID-19 vaccination and employment status among employees of a long-term care network that announced an employee vaccination mandate on July 29, 2021. The day before the announcement, 1,208 employees were unvaccinated; of these workers, 56.2 percent subsequently were vaccinated, whereas 20.9 percent (3.7 percent of active employees) were terminated because of noncompliance with the mandate.
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Affiliation(s)
- Aleksandra M Golos
- Aleksandra M. Golos , University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | - Gretchen B Chapman
- Gretchen B. Chapman, Carnegie Mellon University, Pittsburgh, Pennsylvania
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White EM, Travers JL, Gouskova N, Oh G, Syme M, Yang X, Montoya A, Feifer RA, Grabowski DC, Mor V, Berry SD. Differences In Nursing Home Staff COVID-19 Testing Rates And Odds Of Vaccination Across Work Shifts. Health Aff (Millwood) 2023; 42:217-226. [PMID: 36745839 PMCID: PMC9990769 DOI: 10.1377/hlthaff.2022.01011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
COVID-19 vaccination and regular testing of nursing home staff have been critical interventions for mitigating COVID-19 outbreaks in US nursing homes. Although implementation of testing has largely been left to nursing home organizations to coordinate, vaccination occurred through a combination of state, federal, and organization efforts. Little research has focused on structural variation in these processes. We examined whether one structural factor, the primary shift worked by staff, was associated with differences in COVID-19 testing rates and odds of vaccination, using staff-level data from a multistate sample of 294 nursing homes. In facility fixed effects analyses, we found that night-shift staff had the lowest testing rates and lowest odds of vaccination, whereas day-shift staff had the highest testing rates and odds of vaccination. These findings highlight the need to coordinate resources and communication evenly across shifts when implementing large-scale processes in nursing homes and other organizations with shift-based workforces.
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Affiliation(s)
| | | | | | | | | | | | - Ana Montoya
- Ana Montoya, University of Michigan, Ann Arbor, Michigan
| | - Richard A Feifer
- Richard A. Feifer, RAF Healthcare Solutions, Simsbury, Connecticut
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5
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Pettingell SL, Bershadsky J, Hewitt A, Anderson LL, Zhang A. Direct Support Professionals and COVID-19 Vaccination: A Comparison of Vaccinated and Unvaccinated Direct Support Professionals. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2023; 61:1-15. [PMID: 36706007 PMCID: PMC10161721 DOI: 10.1352/1934-9556-61.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/18/2022] [Indexed: 05/07/2023]
Abstract
Direct support professionals (DSPs) may be at increased risk of contracting COVID-19 due to the proximal nature of their work. In response to the pandemic a three-wave study was launched to understand experiences of DSPs. An on-line national survey found that 70% of DSPs were vaccinated. Vaccinated DSPs were older and had higher education levels. Among the unvaccinated, 56% reported concerns about COVID-19 vaccination safety. Unvaccinated DSPs were more likely to report that the people they supported were also unvaccinated. Encouraging DSPs to get vaccinated to protect the people they support is essential. Paid time off, arranging for vaccinations, and setting an expectation for vaccination may encourage vaccination uptake among DSPs.
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Affiliation(s)
- Sandra L Pettingell
- Sandra L. Pettingell, Julie Bershadsky, Amy Hewitt, Lynda Lahti Anderson, and Alicia Zhang, University of Minnesota
| | - Julie Bershadsky
- Sandra L. Pettingell, Julie Bershadsky, Amy Hewitt, Lynda Lahti Anderson, and Alicia Zhang, University of Minnesota
| | - Amy Hewitt
- Sandra L. Pettingell, Julie Bershadsky, Amy Hewitt, Lynda Lahti Anderson, and Alicia Zhang, University of Minnesota
| | - Lynda Lahti Anderson
- Sandra L. Pettingell, Julie Bershadsky, Amy Hewitt, Lynda Lahti Anderson, and Alicia Zhang, University of Minnesota
| | - Alicia Zhang
- Sandra L. Pettingell, Julie Bershadsky, Amy Hewitt, Lynda Lahti Anderson, and Alicia Zhang, University of Minnesota
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6
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Lee JT, Sean Hu S, Zhou T, Bonner KE, Kriss JL, Wilhelm E, Carter RJ, Holmes C, de Perio MA, Lu PJ, Nguyen KH, Brewer NT, Singleton JA. Employer requirements and COVID-19 vaccination and attitudes among healthcare personnel in the U.S.: Findings from National Immunization Survey Adult COVID Module, August - September 2021. Vaccine 2022; 40:7476-7482. [PMID: 35941037 PMCID: PMC9234000 DOI: 10.1016/j.vaccine.2022.06.069] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/07/2022] [Accepted: 06/15/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Employer vaccination requirements have been used to increase vaccination uptake among healthcare personnel (HCP). In summer 2021, HCP were the group most likely to have employer requirements for COVID-19 vaccinations as healthcare facilities led the implementation of such requirements. This study examined the association between employer requirements and HCP's COVID-19 vaccination status and attitudes about the vaccine. METHODS Participants were a national representative sample of United States (US) adults who completed the National Immunization Survey Adult COVID Module (NIS-ACM) during August-September 2021. Respondents were asked about COVID-19 vaccination and intent, requirements for vaccination, place of work, attitudes surrounding vaccinations, and sociodemographic variables. This analysis focused on HCP respondents. We first calculated the weighted proportion reporting COVID-19 vaccination for HCP by sociodemographic variables. Then we computed unadjusted and adjusted prevalence ratios for vaccination coverage and key indicators on vaccine attitudes, comparing HCP based on individual self-report of vaccination requirements. RESULTS Of 12,875 HCP respondents, 41.5% reported COVID-19 vaccination employer requirements. Among HCP with vaccination requirements, 90.5% had been vaccinated against COVID-19, as compared to 73.3% of HCP without vaccination requirements-a pattern consistent across sociodemographic groups. Notably, the greatest differences in uptake between HCP with and without employee requirements were seen in sociodemographic subgroups with the lowest vaccination uptake, e.g., HCP aged 18-29 years, HCP with high school or less education, HCP living below poverty, and uninsured HCP. In every sociodemographic subgroup examined, vaccine uptake was more equitable among HCP with vaccination requirements than in HCP without. Finally, HCP with vaccination requirements were also more likely to express confidence in the vaccine's safety (68.3% vs. 60.1%) and importance (89.6% vs 79.6%). CONCLUSION In a large national US sample, employer requirements were associated with higher and more equitable HCP vaccination uptake across all sociodemographic groups examined. Our findings suggest that employer requirements can contribute to improving COVID-19 vaccination coverage, similar to patterns seen for other vaccines.
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Affiliation(s)
- James T. Lee
- CDC COVID-19 Response, 1600 Clifton Road NE, Atlanta, GA 30333, USA,Corresponding author
| | - S. Sean Hu
- CDC COVID-19 Response, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - Tianyi Zhou
- CDC COVID-19 Response, 1600 Clifton Road NE, Atlanta, GA 30333, USA,Leidos Inc, 2295 Parklake Dr NE Suite 300, Atlanta, GA 30345, USA
| | - Kimberly E. Bonner
- CDC COVID-19 Response, 1600 Clifton Road NE, Atlanta, GA 30333, USA,Epidemic Intelligence Service, CDC, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | | | | | | | - Carissa Holmes
- CDC COVID-19 Response, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | | | - Peng-jun Lu
- CDC COVID-19 Response, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | | | - Noel T. Brewer
- UNC Gillings School of Global Public Health, 325 Rosenau Hall CB #7440 Chapel Hill, NC 27599, USA
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Dyer AH, Fallon A, Noonan C, Dolphin H, O'Farrelly C, Bourke NM, O'Neill D, Kennelly SP. Managing the Impact of COVID-19 in Nursing Homes and Long-Term Care Facilities: An Update. J Am Med Dir Assoc 2022; 23:1590-1602. [PMID: 35922016 PMCID: PMC9250924 DOI: 10.1016/j.jamda.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
Older adults in nursing homes are at greatest risk of morbidity and mortality from SARS-CoV-2 infection. Nursing home residents constituted one-third to more than half of all deaths during the early waves of the COVID-19 pandemic. Following this, widespread adaptation of infection prevention and control measures and the supply and use of personal protective equipment resulted in a significant decrease in nursing home infections and deaths. For nursing homes, the most important determinant of experiencing a SARS-CoV-2 outbreak in the first instance appears to be community-transmission levels (particularly with variants of concern), although nursing home size and quality, for-profit status, and sociodemographic characteristics are also important. Use of visitation bans, imposed to reduce the impact of COVID-19 on residents, must be delicately balanced against their impact on resident, friend or family, and staff well-being. The successful rollout of primary vaccination has resulted in a sharp decrease in morbidity and mortality from SARS-CoV-2 in nursing homes. However, emerging evidence suggests that vaccine efficacy may wane over time, and the use of a third or additional vaccine "booster" doses in nursing home residents restores protection afforded by primary vaccination. Ongoing monitoring of vaccine efficacy in terms of infection, morbidity, and mortality is crucial in this vulnerable group in informing ongoing SARS-CoV-2 vaccine boosting strategies. Here, we detail the impact of SARS-CoV-2 on nursing home residents and discuss important considerations in the management of nursing home SARS-CoV-2 outbreaks. We additionally examine the use of testing strategies, nonpharmacologic outbreak control measures and vaccination strategies in this cohort. Finally, the impact of SARS-CoV-2 on the sector is reflected on as we emphasize the need for adoption of universal standards of medical care and integration with wider public health infrastructure in nursing homes in order to provide a safe and effective long-term care sector.
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Affiliation(s)
- Adam H Dyer
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Aoife Fallon
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Claire Noonan
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Helena Dolphin
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Cliona O'Farrelly
- Comparative Immunology, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Dublin, Ireland; School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nollaig M Bourke
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland; Inflammageing Research Group, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Desmond O'Neill
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sean P Kennelly
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
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McGarry BE, Gandhi AD, Syme M, Berry SD, White EM, Grabowski DC. Association of State COVID-19 Vaccine Mandates With Staff Vaccination Coverage and Staffing Shortages in US Nursing Homes. JAMA HEALTH FORUM 2022; 3:e222363. [PMID: 35983581 PMCID: PMC9338409 DOI: 10.1001/jamahealthforum.2022.2363] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/08/2022] [Indexed: 11/14/2022] Open
Abstract
Question Are state COVID-19 vaccine mandates for US nursing home employees associated with staff vaccination coverage and reported staff shortages? Findings This cohort study of nursing homes in 38 states found that states with a vaccine mandate experienced an increase in staff vaccination coverage compared with facilities in states with no mandate and no worsening of reported staffing shortages following the mandates. Meaning These findings suggest that given the waning vaccine-induced immunity and low booster dose coverage among nursing home staff in many parts of the US, state mandates for booster doses may be warranted to improve and sustain vaccination coverage in nursing homes. Importance Several states implemented COVID-19 vaccine mandates for nursing home employees, which may have improved vaccine coverage but may have had the unintended consequence of staff departures. Objective To assess whether state vaccine mandates for US nursing home employees are associated with staff vaccination rates and reported staff shortages. Design, Setting, and Participants This cohort study performed event study analyses using National Healthcare Safety Network data from June 6, 2021, through November 14, 2021. Changes in weekly staff vaccination rates and reported staffing shortages were evaluated for nursing homes in states with mandates after the mandate announcement compared with changes in facilities in nonmandate states. An interaction between the mandates and county political leaning was considered. Data analysis was performed from February to March 2022. Exposures Weeks after announcement of a state’s COVID-19 vaccine mandate. Main Outcomes and Measures Weekly percentage of all health care staff at a nursing home who received at least 1 COVID-19 vaccine dose, and a weekly indicator of whether a nursing home reported a staffing shortage. Results Among 38 study-eligible states, 26 had no COVID-19 vaccine mandate for nursing home employees, 4 had a mandate with a test-out option, and 8 had a mandate with no test-out option. Ten weeks or more after mandate announcement, nursing homes in states with a mandate and no test-out option experienced a 6.9 percentage point (pp) increase in staff vaccination coverage (95% CI, −0.1 to 13.9); nursing homes in mandate states with a test-out option experienced a 3.1 pp increase (95% CI, 0.5 to 5.7) compared with facilities in nonmandate states. No significant increases were detected in the frequency of reported staffing shortages after a mandate announcement in mandate states with or without test-out options. Increases in vaccination rates in states with mandates were larger in Republican-leaning counties (14.3 pp if no test-out option; 4.3 pp with option), and there was no evidence of increased staffing shortages. Conclusions and Relevance The findings of this cohort study suggest that state-level vaccine mandates were associated with increased staff vaccination coverage without increases in reported staffing shortages. Vaccination increases were largest when mandates had no test-out option and were also larger in Republican-leaning counties, which had lower mean baseline vaccination rates. These findings support the use of state mandates for booster doses for nursing home employees because they may improve vaccine coverage, even in areas with greater vaccine hesitancy.
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Affiliation(s)
- Brian E. McGarry
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Ashvin D. Gandhi
- Anderson School of Management, University of California Los Angeles
| | - Maggie Syme
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Sarah D. Berry
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth M. White
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - David C. Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Chan HY, Zhao YY, Liu L, Chong YY, Cheng HY, Chien WT. Ethical challenges experienced by care home staff during COVID-19 pandemic. Nurs Ethics 2022; 29:1750-1760. [PMID: 35798543 DOI: 10.1177/09697330221111446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Care homes have been disproportionately affected during the COVID-19 pandemic. Practical challenges of enacting infection control measures in care home settings have been widely reported, but little is known about the ethical concerns of care home staff during the implementation of such measures. . OBJECTIVES To understand the ethical challenges perceived by care home staff during the early months of the COVID-19 pandemic. RESEARCH DESIGN An exploratory qualitative study. PARTICIPANTS AND RESEARCH CONTEXT A purposive sample of 15 care home staff in different roles and ranks in Hong Kong was recruited to take part in semi-structured interviews between June and August 2020. ETHICAL CONSIDERATIONS Ethical approval for this study was obtained. Participation was voluntary and anonymous. Participants had the right to withdraw from the study at any time without reprisal. FINDINGS Three themes were identified: unclear legitimacy regarding infection control measures, limited autonomy in choices over infection control measures and inevitable harms to residents' well-being. While the participants expected that they would have legitimated power to implement infection control measures, they were resistant when their right to self-determination of testing and vaccination was infringed. They also felt trapped between ethical duties to protect care home residents from infection risk and the anticipated detrimental effects of infection control measures. CONCLUSIONS The findings of this study reveal tensions among the ethical obligations of care home staff in response to a public health emergency. They highlight the importance of strengthening ethical sensitivity and ethical leadership in identifying and resolving the challenges of pandemic responses.
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Affiliation(s)
- Helen Yl Chan
- Faculty of Medicine, 71024The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ya-Yi Zhao
- School of Nursing, 71024Nanjing University of Chinese Medicine, Nanjing, China
| | - Li Liu
- Xiangya Nursing School, 71024Central South University, Hunan, China
| | - Yuen-Yu Chong
- Faculty of Medicine, 71024The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ho-Yu Cheng
- Faculty of Medicine, 71024The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wai-Tong Chien
- Faculty of Medicine, 71024The Chinese University of Hong Kong, Hong Kong SAR, China
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10
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Mitchell LL, Albers EA, Birkeland RW, Peterson CM, Stabler H, Horn B, Cha J, Drake A, Gaugler JE. Caring for a Relative With Dementia in Long-Term Care During COVID-19. J Am Med Dir Assoc 2022; 23:428-433.e1. [PMID: 34929196 PMCID: PMC8677585 DOI: 10.1016/j.jamda.2021.11.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/10/2021] [Accepted: 11/25/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The COVID-19 pandemic created unique stressors for caregivers of persons with dementia living in long-term care (LTC) facilities. The purpose of this qualitative study was to identify the challenges associated with caring for a relative with dementia in LTC during the pandemic, as well as resources, strategies, and practices caregivers found helpful in coping with COVID-19. DESIGN This study was conducted within the context of an ongoing randomized controlled trial of a psychosocial intervention to support caregivers. Open-ended survey responses (n = 125) and semistructured interviews with a subset of the sample (n = 20) collected between June 2020 and June 2021 explored caregivers' experiences during COVID-19. SETTING AND PARTICIPANTS Participants included 125 family caregivers of persons with dementia living in residential LTC. METHODS Thematic analysis was used to identify themes capturing caregivers' experiences. RESULTS In addition to concerns about COVID-19 infection, participants reported key challenges such as the difficulty of maintaining contact with relatives because of visiting restrictions, lack of information about relatives' health and well-being, worries about overburdened LTC staff, impossibility of returning relatives home from the LTC facility, and fears about relatives dying alone. Participants also identified resources, strategies, and practices that they perceived as helpful, including effective infection prevention within the LTC facility, good communication with LTC staff, and creative strategies for connecting with their relatives. CONCLUSIONS AND IMPLICATIONS This qualitative analysis informs recommendations for practice within LTC facilities, as well as supports that may help caregivers manage stressful situations in the context of COVID-19. Vaccination and testing protocols should be implemented to maximize family caregivers' opportunities for in-person contact with relatives in LTC, as alternative visiting modalities were often unsatisfactory or unfeasible. Informing caregivers regularly about individual residents' needs and status is crucial. Supports for bereaved caregivers should address complicated grief and feelings of loss.
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Affiliation(s)
- Lauren L Mitchell
- Department of Psychology & Neuroscience, Emmanuel College, Boston, MA, USA.
| | | | - Robyn W Birkeland
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Henry Stabler
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Brenna Horn
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Jinhee Cha
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Anna Drake
- Department of Psychology & Neuroscience, Emmanuel College, Boston, MA, USA
| | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
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11
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Wang B, Nolan R, Marshall H. COVID-19 Immunisation, Willingness to Be Vaccinated and Vaccination Strategies to Improve Vaccine Uptake in Australia. Vaccines (Basel) 2021; 9:vaccines9121467. [PMID: 34960213 PMCID: PMC8704895 DOI: 10.3390/vaccines9121467] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/28/2021] [Accepted: 12/07/2021] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 vaccine rollout is crucial to lifting community and economic restrictions. This cross-sectional study aimed to assess: (a) COVID-19 vaccine uptake and associated factors; (b) COVID-19 vaccine intentions and associated factors; (c) community support for COVID-19 vaccination strategies and associated factors. The survey was conducted between May and July 2021 in Australia. Of 3003 participants, 30% reported they were already vaccinated and 39% indicated they would get vaccinated. Low socioeconomic and education levels, non-English speaking backgrounds and being parents were associated with decreased vaccine willingness and/or vaccination rates. High levels of support for vaccination strategies were demonstrated with mandatory vaccination being less preferable. Respondents from non-English speaking backgrounds were more likely to support a mandatory vaccination policy. Respondents with the highest socioeconomic level were more likely to support vaccination requirements for international travel, visiting nursing homes and working in healthcare settings. Respondents who were aged ≥70 years were more likely to support all proposed vaccination strategies. Targeted campaigns should be implemented for parents and those who live in socioeconomic disadvantaged areas and have lower educational attainment. Concise and clear vaccine information should be provided in lay and multiple languages to improve vaccine confidence. Vaccine enforcement policies should be considered and implemented with caution.
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Affiliation(s)
- Bing Wang
- Vaccinology and Immunology Research Trials Unit, Women’s and Children’s Health Network, Adelaide, SA 5006, Australia;
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, SA 5006, Australia
| | - Rebecca Nolan
- Epidemiology Branch, Prevention and Population Health Directorate, Wellbeing SA, Adelaide, SA 5006, Australia;
| | - Helen Marshall
- Vaccinology and Immunology Research Trials Unit, Women’s and Children’s Health Network, Adelaide, SA 5006, Australia;
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, SA 5006, Australia
- Correspondence: ; Tel.: +61-8-8161-8115
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12
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Zimmerman S, Gaugler JE, Nkimbeng M. COVID-19 Vaccination and Implementation Science: How One Can Benefit the Other. J Am Med Dir Assoc 2021; 22:2223-2224. [PMID: 34716004 PMCID: PMC8547910 DOI: 10.1016/j.jamda.2021.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Joseph E Gaugler
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Manka Nkimbeng
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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13
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Miller EA. Shining a Spotlight: The Ramifications of the COVID-19 Pandemic for Older Adults. J Aging Soc Policy 2021; 33:305-319. [PMID: 34542025 DOI: 10.1080/08959420.2021.1973343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The COVID-19 pandemic has disrupted life globally through virus-related mortality and morbidity and the social and economic impacts of actions taken to stop the virus' spread. It became evident early in the pandemic that COVID-19 and the strategies adopted to mitigate its effects would have a disproportionate impact on older adults. This special issue of the Journal of Aging & Social Policy reports original empirical research and perspectives on the ramifications of the COVID-19 pandemic for this population. This introductory essay highlights key issues pertaining to the impact of COVID-19 on older adults and their families, caregivers, and communities. The prevalence and susceptibility of COVID-19 infection in the older adult population is discussed, including the devastating consequences of the pandemic for residents and staff of long-term care facilities. This is followed by a brief examination of ageism and social isolation brought to the fore during the pandemic, as well as the adverse effects of the pandemic for the economy and racial and ethnic minority populations. It concludes with an overview of issue content.
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Affiliation(s)
- Edward Alan Miller
- Professor and Chair, Department of Gerontology, and Fellow, Gerontology Institute, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts, Boston, Massachusetts, USA.,Adjunct Professor of Health Services, Policy and Practice, Brown University, Providence, Rhode Island, USA
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Mandating COVID-19 Vaccine for Nursing Home Staff: An Ethical Obligation. J Am Med Dir Assoc 2021; 22:1967-1968. [PMID: 34487686 PMCID: PMC8387223 DOI: 10.1016/j.jamda.2021.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/20/2022]
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