Colliding worlds: Family carers' experiences of balancing work and care in Ireland during the COVID-19 pandemic

Factors associated with mental health outcomes among family caregivers to adults with COVID: a scoping review

PURPOSE

Family caregivers (FCGs) are essential to the health and wellbeing of people affected by COVID. Protecting mental health of FCGs is essential to sustaining their caregiving role. The objective of this scoping review was to synthesise identified risks factors and protective factors for mental health of FCGs to adults with COVID.

MATERIALS AND METHODS

Using the Joanna Briggs Institute (JBI) methodology, the search was conducted across Medline, CINAHL, and PsycINFO. Original studies conducted since the pandemic began were included. The population was adult FCGs to adults with COVID, and studies reported mental health outcomes and related factors.

RESULTS

Of 3474 identified articles, 22 met inclusion criteria (14 quantitative, seven qualitative, one mixed-methods, 18/22 conducted in Iran). Across all study designs, risk factors included limited support, financial burden, family challenges, unpredictable nature of COVID, inexperience, isolation, and unpleasant experiences. Protective factors included accessing support services, self-reinforcement, coping strategies, professional help, and online intervention.

CONCLUSIONS

Quantitative and qualitative research identified common mental health risk factors and protective factors for FCGs to adults with COVID. These factors may inform development of supports and services for FCGs to people with COVID, such as online interventions. Studies did not distinguish acute versus long COVID.

A qualitative exploration of balancing family, work, and academics among female graduate nursing students in a lower-middle-income country

Career women have varied responsibilities in society, and therefore, finding a balance among work, family, and personal life duties is becoming increasingly difficult. The literature explains that there is no one-size-fits-all standard for work-life balance. This study sought to explore ways of coping with family life and schooling among Ghanaian nurses and midwives pursuing graduate programmes without study leave. The paper was carved out of a more extensive study exploring female graduate students' life experiences, combining work, family, and schooling. The study used an exploratory descriptive qualitative design through a purposive sampling approach to recruit 20 female nurses and midwives pursuing graduate programmes in three public universities in Ghana. The study obtained ethics approval from the Noguchi Memorial Institutes of Medical Research. Participants used social media, people in their social circles and religion to cope. Families, friends, church leaders, managers at work, and coursemates assisted in various ways. The support was in the form of money, help with household chores and childcare, granting off days, assistance with assignments, and counselling. Participants neglected the care of their husbands and children to concentrate on work and schooling. The graduate students watch movies, TikTok videos and listen to various music. Some forced themselves to sleep and as well, walk with loved ones to relief stress. Above all, participants relied on God via prayers and words of inspiration from motivational speakers. The authors believe that establishing and implementing family-friendly human resource policies targeting career women to empower themselves through graduate education will be beneficial.

'Turbulence even in a bubble': a reflexive thematic analysis with family caregivers of people with dementia in the United Kingdom during and beyond the COVID-19 pandemic

OBJECTIVE

This study aimed to understand how family caregivers of people with dementia managed changes caused by COVID-19 restrictions and how they adjusted to the lifting of restrictions. A particular focus of the study was on understanding the impact of social isolation, a reduction of social interactions, and reduced access to healthcare services.

METHODS AND MEASURES

Fourteen voluntary caregivers (nine women) were interviewed using a semi-structured interview schedule.

RESULTS

Five themes were identified based on reflexive thematic analysis: (i) Outlets to cope with lockdown; (ii) 'Not all doom and gloom': A silver lining amid COVID-19; (iii) Optimism helps provide resilience; (iv) The challenges and joys of reopening; and (v) Caregiving toward a new normality.

CONCLUSION

The research highlighted difficulties reported by family caregivers and people with dementia during COVID-19, while also showing how such carers coped. Interviews also identified ways that family caregivers often used optimism to help navigate through lockdown and to tackle the reopening stage. Family caregivers in this study reported coping well overall, but welcomed the lifting of restrictions.

Unpaid caregiving and mental health during the COVID-19 pandemic-A systematic review of the quantitative literature

The COVID-19 pandemic imposed additional and specific challenges on the lives and wellbeing of informal unpaid carers. Addressing an important gap in the existing literature, this systematic review (prospectively registered with PROSPERO CRD42022376012) synthesises and evaluates the quantitative evidence examining the association between unpaid caregiving and mental health (compared to non-caring), during the pandemic. Five databases were searched (Medline, PsycInfo, EMBASE, Scopus, Web of Science) from Jan 1, 2020, to March 1, 2023. Population-based, peer-reviewed quantitative studies using any observational design were included, with screening, data extraction and quality assessment (amended NOS) independently conducted by two reviewers. Of the 3,073 records screened, 20 eligible studies (113,151 participants) were included. Overall quality of evidence was moderate. Narrative synthesis was complemented by Effect-direction and Albatross plots (given significant between-study heterogeneity precluded meta-analysis). Results indicate that the mental health of informal carers, already poorer pre-COVID compared to non-caregivers, was disproportionally impacted as a result of the pandemic and its associated public health containment measures. This review highlights the vulnerability of this group and should motivate political will and commensurate policies to ensure unpaid caregivers are better supported now, in the medium term, and crucially if, and when, another global public health emergency emerges.

Experiences of UK and Irish family carers of people with profound and multiple intellectual disabilities during the COVID-19 pandemic

BACKGROUND

People with profound and multiple intellectual disabilities (PMID) have high and intensive support needs that ordinarily place significant strain on family carers. This was further heightened by the removal of many external supports during the COVID-19 pandemic. We sought to explore the experiences of family carers of people with PMID during the COVID-19 pandemic and understand what the longer-term impact might be on their lives.

METHODS

Focus group interviews (n = 32) were conducted with family carers (n = 126) from the four countries of the UK and the Republic of Ireland. Participants were asked questions relating to their experiences of the COVID-19 pandemic, coping strategies, and challenges faced. All focus groups were conducted using the online platform, Zoom. These were audio recorded, transcribed verbatim and analysed employing inductive thematic analysis.

FINDINGS

Three main themes were generated from the data including (1.0) COVID-19 as a double-edged sword (2.0), The struggle for support (3.0), Constant nature of caring. These included 11 subthemes. (1.1) 'COVID-19 as a catalyst for change', (1.2) 'Challenges during COVID-19: dealing with change', (1.3) 'Challenges during COVID-19: fear of COVID-19', (1.4); 'The online environment: the new normal' (2.1) 'Invisibility of male carers', (2.2) 'Carers supporting carers', (2.3) 'The only service you get is lip service: non-existent services', (2.4); 'Knowing your rights' (3.1) 'Emotional response to the caring role: Feeling devalued', (3.2) 'Emotional response to the caring role: Desperation of caring', (3.3) 'Multiple demands of the caring role.'

CONCLUSIONS

The COVID-19 pandemic presented immense challenges to family carers of people with PMID but also provided some opportunities. Families had already struggled to receive many of the supports and services to which they were entitled to only to have these removed at the onset of the pandemic. The experiences of male carers have been largely absent from the literature with this research showing they want to be included in decision making and require tailored support services. Service providers should see the end of the COVID-19 pandemic as providing opportunity to re-examine current provision and design services with family carers. As the direct threat from COVID-19 diminishes and the experiences of those who lived through this period come to the fore, there is a need to re-examine current models and provision of support to family carers to better meet their needs.

A Systematic Review of the Impact of Remote Working Referenced to the Concept of Work-Life Flow on Physical and Psychological Health

BACKGROUND

COVID-19 accelerated the adoption of remote working in which employers' obligations for employees' health and well-being extended into the home. This paper reports on a systematic review of the health impacts of remote working within the context of COVID-19 and discusses the implications of these impacts for the future role of the occupational health nurse.

METHOD

The review protocol was registered with PROSPERO (CRD42021258517) and followed the PRISMA guidelines. The review covered 2020-2021 to capture empirical studies of remote working during the COVID-19 pandemic, their physical and psychological impacts and mediating factors.

RESULTS

Eight hundred and thirty articles were identified. After applying the inclusion criteria, a total of 34 studies were reviewed. Most studies showed low to very low strength of evidence using the GRADE approach. A minority of studies had high strength of evidence. These focused on the reduced risk of infection and negative effects in terms of reduced physical activity, increased sedentary activity, and increased screen time.

CONCLUSION/APPLICATION TO PRACTICE

The synergy of work and personal well-being with the accelerated expansion of remote working suggests a more active role in the lives of workers within the home setting on the part of occupational health nurses. That role relates to how employees organize their relationship to work and home life, promoting positive lifestyles while mitigating adverse impacts of remote working on personal well-being.

Mental health, social integration and support of informal caregivers during the second wave of the COVID-19 pandemic: A population-based representative study from Germany

INTRODUCTION

The study analyzed mental health, social integration and social support of informal caregivers of individuals aged ≥60 years compared to non-caregivers during the second wave of the COVID-19 pandemic.

METHODS

A quantitative, cross-sectional study was conducted with a sample drawn randomly from the nationally representative online panel forsa.omninet in Germany between March 4th and 19th 2021. In total, 3022 adults aged ≥40 years from Germany were questioned, including 489 adults providing informal care for adults aged ≥60 years between December 2020 and March 2021. Depressive (PHQ-9) and anxiety symptoms (GAD-7), loneliness (De Jong Gierveld Scale), social exclusion (Bude & Lantermann Scale) and social network support (Lubben's Social Network Scale) were measured. Adjusted OLS regression analyses and additional moderator analyses (moderators: perceived restrictions and danger of infection due to the COVID-19 pandemic) were conducted.

RESULTS

Significant higher levels of depressive and anxiety symptoms and more social support were found among informal caregivers compared to non-caregivers. Loneliness and social exclusion did not differ between both groups. Perceived restrictions by the pandemic significantly moderated the association between informal caregiving and social support - social support was stronger among caregivers with higher levels of perceived restrictions by the pandemic.

CONCLUSION

Informal caregivers are faced with worse mental health than non-caregivers during the pandemic, although their social support was stronger, in particular in dependence of higher levels of perceived restrictions by the pandemic. Thus, results indicate a need for an informal-care-specific policy and more professional support for informal caregivers during a health crisis.

Caregivers' experiences of caring for non-COVID-19 patients during the pandemic: A qualitative systematic review

OBJECTIVE

To investigate caregivers' experiences of caring for non-coronavirus disease (COVID-19) patients to determine their challenges and needs.

METHODS

Five electronic databases (PubMed, Web of Science, Ovid, CINAHL, and ClinicalKey) were searched from January 2020 to June 2022. Two authors independently reviewed all studies for eligibility and extracted information on the study aim, sample characteristics, study design, data collection, analysis methods, and so on.

RESULTS

Finally, 13 studies were included. Four themes were determined: impacts on physical and psychosocial well-being of caregivers, perceived risk of the virus, negative impacts on employment and financial statuses, and changes in support networks.

CONCLUSION

This is the first qualitative systematic review to describe caregivers' experiences of caring for non-COVID-19 patients during the pandemic. The four themes should be focused on to ease caregivers' physical, psychological, and financial burdens; to provide them with better assistance in terms of formal and informal supports to cope with the epidemic more effectively; and to ensure that their loved ones are much healthier.

PRACTICE IMPLICATIONS

The findings can be used by healthcare policymakers, social policymakers, and governments to better support caregivers of non-COVID-19 patients. Additionally, it provides suggestions for related medical institutions to pay more attention to caregivers' experiences.

The effect of resource loss on depression and peritraumatic distress during the early period of the COVID-19: considering the pandemic-situational and social context

BACKGROUND

The public experienced loss of resources, including their health and property during the COVID-19 pandemic. The Conservation of Resources (COR) theory is a useful tool to explain the effect of resource loss on mental health. This paper examines the effect of resource loss on depression and peritraumatic distress considering the situational and social context of the COVID-19 pandemic applying COR theory.

METHODS

An online survey was conducted for Gyeonggi residents when the second wave of COVID-19 in South Korea declined (5 October to 13 October 2020); 2,548 subjects were included in the hierarchical linear regression analysis.

RESULTS

COVID-19 infection-related experiences, resource losses (e.g., financial burden, deterioration of health, and decline of self-esteem), and fear of stigma were related to elevated levels of peritraumatic distress and depression. Risk perception was associated with peritraumatic distress. Reduced income or job loss were related to depression. Social support was a protective factor for mental health.

CONCLUSIONS

This study suggests that we need to focus on COVID-19 infection-related experiences and loss of daily resources in order to understand mental health deterioration during the COVID-19 pandemic. Moreover, it is important to monitor the mental health of medically and socially vulnerable groups and those who have lost resources due to the pandemic and to provide them with social support services.

Impact of COVID-19 Pandemic on Caregivers of People with an Intellectual Disability, in Comparison to Carers of Those with Other Disabilities and with Mental Health Issues: A Multicountry Study

Carers supporting people with an intellectual disability often rely on others to manage the burden of care. This research aims to compare the differences between carer groups and understand the predictors of loneliness changes and burden for carers of people with an intellectual disability. Data from the international CLIC study were analysed. In total, 3930 carers responded from four groups; people who care for those with mental health difficulties (n = 491), dementia (n = 1888), physical disabilities (n = 1147), and Intellectual disabilities (n = 404). Cross tabulation and the chi-squared test were used to compare group compositions and binary logistic regression to model predictors within the intellectual disability group. A total of 65% of those caring for people with an intellectual disability experienced increased burden, and 35% of carers of people with an intellectual disability and another condition experienced more severe loneliness. Becoming severely lonely was predicted by feeling burdened by caring (AOR, 15.89) and worsening mental health (AOR, 2.13) Feeling burden was predicted by being aged between 35 and 44 (AOR, 4.24), poor mental health (AOR, 3.51), and feelings of severe loneliness prior to the pandemic (AOR, 2.45). These findings demonstrate that those who were already struggling with caring experienced the greatest difficulties during the COVID-19 lockdowns.

Patient-reported experience of clinical care of osteogenesis imperfecta (OI) during the COVID-19 pandemic

Background

Research on the effects of the COVID-19 pandemic on people with rare diseases is limited. Few studies compare healthcare throughout the progression of the ongoing pandemic.

Aims

To assess the impact of the pandemic on individuals with osteogenesis imperfecta across two consecutive years, understand what challenges were encountered, and analyse the experience of remote consultation.

Methods

An initial survey was distributed following the first lockdown in August 2020, and a second survey in April 2021. The surveys explored four themes- effects on therapy, alternatives to consultation, effect on mental health, and perceived risks of COVID-19.

Results

In the 2020 survey, of the 110 respondents, 69 (63%) had at least one appointment delayed due to the lockdown, compared with 89 of the 124 respondents (72%) in 2021. Of the 110 respondents in 2020, 57 (52%) had a remote consultation, increasing to 92 of 124 (74%) in the follow-up survey. In the 2020 survey 63 of 91 respondents (69%) expressed anxiety due to lockdown, compared with 76 of 124 (61%) in 2021. The percentage of total respondents expressing a preference for remote consultation was 48% in 2020, increasing to 71% in 2021.

Conclusions

The pandemic has had widespread effects on the mental and physical health of those with OI. These effects, alongside appointment delays, have increased as the pandemic progresses. Encouragingly, the increasing preference for remote consultation may indicate that this could be a viable long-lasting alternative to face-to-face appointments, especially for patients who previously traveled vast distances for specialist care.

Impacts of the COVID-19 pandemic on carer-employees' well-being: a twelve-country comparison

The aim of this analysis is to assess the potential ways that the COVID-19 pandemic has impacted Canadian carer-employees (CEs) and identify the needs CEs feel is required for them to continue providing care. We assess the similarities and differences in the stresses CEs faced during COVID-19 globally across countries in the G7, Australia, Spain, Brazil, Taiwan, India, and China. We aim to compare Canada against global trends with respect to the challenges of the COVID-19 pandemic, as well as the supports in place for CEs. The study utilized 2020 Carer Well-Being Index at the country level. Descriptive data on Canadian CEs is first reviewed, followed by comparisons, by country, on responses relating to: (a) time spent caring; (b) sources of support; (c) impact on paid work and career, and; (d) emotional/mental, financial, and physical health. The relationship between government support and emotional/mental health is also explored. When compared to pre-pandemic times, CEs in Canada on average spent more time caregiving, with 34% reporting more difficulty balancing their paid job and caring responsibilities. Seventy-one percent of CEs feel their mental health has deteriorated. Thirty-four percent of Canadian CEs received support from the government, and only 30% received support from their employers. Globally, there was a similar trend, with CEs experiencing deteriorating mental health, work impacts, and unmet needs during the pandemic. Comparing the well-being of Canadian CEs with other countries provides an opportunity to evaluate areas where Canadian policies and programs have been effective, as well as areas needing improvement.

Informal care in times of a public health crisis: Objective burden, subjective burden and quality of life of caregivers in the Netherlands during the COVID-19 pandemic

In the Netherlands, about one-third of the adult population provides unpaid care. Providing informal caregiving can be very straining in normal times, but the impact of a public health crisis on caregivers is largely unknown. This study focuses on the question of how caregiver burden changed following the COVID-19 pandemic, and what characteristics were related to these changes. We use self-reported data from a sample of 965 informal caregivers from the Netherlands 3 months into the pandemic to investigate how the objective burden (i.e. hours spent on caregiving) and the subjective burden had changed, and what their care-related quality of life (CarerQol) was. We found that on average the subjective burden had increased slightly (from 4.75 to 5.04 on a 0-10 scale). However, our analysis revealed that some caregivers were more affected than others. Most affected caregivers were women, and those with low income, better physical health, decreased psychological health, childcare responsibilities, longer duration of caregiving and those caring for someone with decreased physical and psychological health. On average, time spent on care remained the same (a median of 15 h per week), but certain groups of caregivers did experience a change, being those caring for people in an institution and for people with a better psychological health before the pandemic. Furthermore, caregivers experiencing changes in objective burden did not have the same characteristics as those experiencing changes in perceived burden and quality of life. This shows that the consequences of a public health crisis on caregivers cannot be captured by a focus on either objective or subjective burden measures or quality of life alone. Long-term care policies aiming to support caregivers to persevere during a future crisis should target caregivers at risk of increased subjective burden and a lower CarerQol, such as women, people with a low income and people with childcare responsibilities. Such policies should consider that reducing objective burden may not necessarily lead to a reduction in subjective burden for all caregivers.

Exploring loss and grief during the COVID-19 pandemic: A scoping review of qualitative studies

Introduction: The COVID-19 pandemic has brought about multiple losses to various groups, namely patients, families and healthcare professionals. Grief, which is the reaction to these losses, could cause strain on these individuals’ physical and mental health if not identified and managed early. This scoping review analysed loss, grief and how they were managed among these groups during the pandemic. Method: This scoping review utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement extension for Scoping Reviews (PRISMA-ScR) and the Joanna Briggs Institute framework for scoping reviews. Only qualitative studies relating to loss and grief and their management were included. Of 166 studies screened, 69 were included in the study. Qualitative analysis and data coding of each record were conducted through qualitative data analysis software. Results: Losses included the death of family members, patients, colleagues and others. They also included the loss of usual routines, lifestyles and physical health. The grief experienced was multidimensional, affecting mainly the emotional, physical, social and existential realms. Anger, guilt and fear resulted from unsatisfactory farewells, issues with funerals, social isolation, financial strain and stigmatisation. Management strategies could be categorised into 5 themes: communication, finance, counselling, education and spiritual care. Conclusion: Loss and grief identification and management among patients, family members and healthcare professionals are critically important during this COVID-19 pandemic. Current operating guidelines have proven insufficient in managing loss and grief. Innovative strategies are essential to tackle the many dimensions of loss and grief. Nevertheless, further research is necessary to better understand the effectiveness of implemented policies. Keywords: Bereavement, death, mourning, outbreak, palliative care

Buffering the Effects of Burnout on Healthcare Professionals' Health-The Mediating Role of Compassionate Relationships at Work in the COVID Era

Managing the COVID-19 pandemic posed several challenges for healthcare professionals, which likely heightened their risk of burnout (Amanullah and Ramesh Shankar, 2020) and, consequently, their general physical and mental health. Although it may not be possible to address and eliminate the causes of burnout, current research informs healthcare organizations about protective strategies to reduce its detrimental consequences. The promotion of compassionate interactions among healthcare professionals may play such a role. Compassion within healthcare organizations positively affects individual performance and well-being. Building on these considerations and within the framework of the Conservation of Resources theory, this study explores the relationships among burnout dimensions, received compassion at work, and general health in 711 Italian healthcare professionals (68.5% female), aged between 21 and 73 years (Mage = 36.4, SD = 11.2). Analyses were conducted to investigate the association between burnout and general well-being (H1) and between burnout symptoms and perceived compassion at work (H2); and the mediational role of compassion in the relationship between burnout symptoms and general well-being. H1 and H2 were confirmed (r < 0.01 for both), and a SEM model showed the mediating role of compassion at work in the association between burnout symptoms and general well-being (RMSEA < 0.08, SRMR < 0.08, CFI and TLI > 0.90). Theoretical and practical implications of the findings are discussed in the paper.

Work-Family Interface in the Context of Social Responsibility: A Systematic Literature Review

The literature on internal social responsibility, in which the work-family interface can be included, already has a robust tradition in scientific research. It is, therefore, important to systematize the path that has been taken and what the future may hold. This article aims to systematize the literature that simultaneously focuses on the work-family relationship and on the context of social responsibility and sustainability, with the purpose of mapping the research that has been produced on these intersections. A systematic review of the literature was conducted between the period 1968 and 2021. The search was performed on the SCOPUS database, and the analysis was conducted using the VOSviewer software, with 333 articles having been identified and subjected to a bibliometric and content analysis. As a result, 88 articles were analyzed in depth, focusing on the Work and Life Space dimension and the work-family relationship. The results indicate that corporate social responsibility has a positive effect on the work-family relationship, where an efficient balance between personal and professional life is often measured based on the adequacy of the adjustment of factors such as working hours and social and family commitments.

Places of paid work and unpaid work: Caregiving and work-from-home during COVID-19

Eldercare and places of eldercare have been radicalized with the advent of COVID-19. Growing concerns about the safety of long-term care homes, coupled with the continuation of stay-at-home orders, mean that carers are reconstructing new meanings and places of care provision. Increasingly for many Canadians, the home is rapidly becoming the nexus of one's domestic, work, and caregiving world. By interviewing working carers (n = 5) living throughout Canada, this study investigates the changing meanings of home as a place for care during the COVID-19 pandemic. Drawing upon lived experiences of informal carers engaged in the workforce, we observe a blurring of spatial and temporal boundaries between places of work and places of care. Specifically, we note that the integration of carescapes and workscapes into a single domain presents both benefits and tensions to carers, such as increased schedule flexibility and disruptions at work, respectively. Parallel to this, we also explore how previous places of safety and respite, such as independent senior residences and long-term care homes, are perceived as sites of danger and anxiety due to the vulnerability of seniors to COVID-19. This dynamic is likely to continue well into the future, as long-term care homes fall out of favour and carers adopt a more integrated approach to caregiving within their daily lives.