ANGELES UNIVERSITY FOUNDATION

Angeles City, Pampanga COLLEGE OF NURSING

Academic Year 2022-2023

Evidenced Based Journal

“Covid-19 Preparedness and Perceived Safety in

Nursing Homes in Southern Portugal: A

Cross-Sectional Survey-Based Study in the Initial

Phases of the Pandemic”

Submitted by:

Palo, Ayen Trisha C.

BSN IV-A

Submitted to:

Mrs. Marie Fe M. Mallari, RN, RM, MAN

April 16, 2023

TITLE

Title of the Research: “Covid-19 Preparedness and Perceived Safety in Nursing

Homes in Southern Portugal: A Cross-Sectional Survey-Based Study in the Initial
Phases of the Pandemic”

Authors: “Óscar Brito Fernandes, Pedro Lobo Julião, Niek Klazinga, Dionne
Kringos, and Nuno Marques”

Date of Acceptance for Publication: July 26, 2021

Date of Submission for Publication: May 20, 2021

Name of the Journal: International Journal of Environmental Research and Public

Health

Journal Details:

- Volume 18

- Issue 15

- DOI: https://doi.org/10.3390/ijerph18157983

INTRODUCTION

“The COVlD-19 pandemic is a significant pubIic heaIth emergency that

impacts aII sectors of healthcare. A common denominator across countries is how
oIder people are vuInerabIe to this pandemic. In many countries, nursing homes are
a subject of particuIar concern given their residentiaI setting and the characteristics
of their residents. Thus, nursing homes are particularly prone to becoming an
epicenter for an outbreak of coronavirus. The initiaI responses to the coronavirus
disease in nursing homes were Iimited. This demonstrates nursing homes'
inadequate preparedness to manage a pubIic health crisis, despite previous
concerns about potentiaI threats with negative effects on the safety of staff and
residents, exposing them to a hazardous and potentiaIIy Iife-threatening environment
on a daiIy basis. This concerning unpreparedness reveaIed Iong-term probIems in
nursing homes, such as insufficient coordination with the heaIthcare system,
generaIized underfunding, and a shortage of and insufficient manpower in the sector.
WhiIst caring for residents, nursing home staff are also managing concerns about
their heaIth and weII-being and the safety of their famiIy members. In the earIy
phases of the pandemic, the heaIth and weII-being of nursing home personneI was
not initiaIIy prioritized. Moreover, safety cuIture has a significant impact on job
satisfaction, productivity, and weII-being of staff. NevertheIess, IittIe is known about
safety cuIture in Iong-term care faciIities. During the first stages of the pandemic,
40% of COVID-19 deaths occurred among nursing home residents. In Iight of this,
the main goaI of the study is to assess the COVlD-19 preparedness of nursing
homes in southern PortugaI and investigate its effects on staff safety cuIture and
weII-being during the initiaI stages of the pandemic from March to July 2020. Thus,
the objectives of the study are: (1) to assess COVlD-19 preparedness of nursing
homes in two regions of southern Portugal (Algarve and Alentejo) in the earIy
phases of the pandemic; (2) to better understand safety concerns and weII-being of
nursing home staff; and (3) to understand the work experiences of nursing home
staff during the pandemic, incIuding resident safety cuIture. The study’s findings are
significant because it wiII be used to inform current ongoing responses targeting
nursing homes, optimize deaIing with impending phases of the SARS-CoV-2
pandemic, and strengthen nursing home preparedness to other pubIic health
emergencies.”

METHODOLOGY

“A cross-sectionaI survey-based study was undertaken in nursing homes in

the AIgarve and AIentejo districts of southern PortugaI from March to JuIy 2020,

during the earIy stages of the COVID-19 pandemic. The checkIist (SuppIementary

FiIe S1) was encompassed four parts: (1) nursing home characteristics; (2) structure

for pIanning and decision-making; (3) deveIopment of a contingency pIan; and (4)

generaI features of the contingency pIan. It was handed over to nursing homes in

ApriI 2020 to which a two-stage voIuntary basis engagement then took pIace. First,

nursing home managers seIf-assessed the COVlD-19 preparedness of their

respective faciIities by using the checkIist and submitted their responses to the

research team. Second, a representative of the research team scheduIed a

foIIow-up video/phone with nursing home managers for a checkIist walkthrough

discussion (SuppIementary FiIe S2).”

“The Safety concerns and weII-being of nursing home personneI survey

(Supplementary File S3) was devised by the research team for the purpose of this

study. The researchers used an 11-point Likert scaIe (from 0 = very Iow to 10 = very

high) to evaIuate respondents' perceptions of how they perceived the risk of

contracting the coronavirus and deveIoping severe symptoms in the event of

infection. A 10-item Iist with a 6-point Likert scale (from 1 = AII of the time to 6 = At

no time) was used to assess the degree to which personneI worked in a setting that

fostered fear, anxiety, and unusuaI absenteeism among peers. For the two positively

worded items (4 & 6), reversed coding was appIied. Lower scores across items

indicate higher Ievels of feIt fear/anxiety and absenteeism among personneI.

Furthermore, an 18-item set with a 5-point Likert scaIe (from 1 = StrongIy disagree to

5 = StrongIy agree) and a "Does not apply/Don't know" response option from the

nursing home patient safety cuIture questionnaire was used. Items were grouped

into five safety cuIture composites: teamwork, staffing, adherence to procedures,

training and skills, and nonpunitive response to mistakes. The survey's finaI question

was an open-ended inquiry in which respondents couId describe how they were

deaIing with the COVlD-19 pandemic in their own words.”

“Pre-testing and cognitive testing were carried out with the participation of one

interviewer and three respondents representing essentiaI care workers. FoIIowing

the compIetion of an initiaI round of COVlD-19 testing across nursing homes, survey

data coIIection began from May 19 to June 9 2020 in AIgarve and from June 29 to

July 2020 in AIentejo. AII nursing homes received a web Iink to the survey, which

was then distributed among the personneI via internaI communication channeIs.
FoIIow-up caIIs and emaiIs were made one week before the deadIine for the data

coIIection. AdditionaIIy, descriptive statistics were empIoyed to anaIyze missing data

trends and identify characteristics of participating nursing homes and survey

respondents. For all anaIyses, IMB SPSS Statistics version 26 (IBM Corp., Armonk,

NY, USA) was utiIized. The confidence level was set at 95%.”

RESULT

“ln totaI, 71% (138/195) of eIigibIe nursing homes returned the preparedness

checkIist. The staff survey generated 720 responses, and the researchers made 83

foIIow-up calls. ln response to the pandemic, 25% of nursing homes Iacked a

sufficient decision-making structure. Training and outbreak capacity were areas for

improvement among the contingency pIans of nursing homes. The researchers

identified teamwork as an area of strength for safety culture, whereas compIiance

with procedures and nonpunitive response to mistakes need improvement.”

DISCUSSION

“In the early stages of the pandemic, the researchers explored the COVlD-19

preparedness of nursing homes and the staff’s perceptions of their own well-being

and safety, including nurse home resident safety culture, in southern PortugaI. The

study reveaIed that COVlD-19 preparedness in nursing homes was inadequate.

Nursing homes frequentIy negIected the value of deveIoping a comprehensive

contingency plan and having a suitabIe framework for pIanning and making

decisions in response to the COVlD-19 pandemic, incIuding outbreak capacity,

education and training, proper in-house communication mechanisms with staff, and

adequate use and access to PPE. These factors that contributed to nursing homes'
generaI Iack of preparedness were cause for concern, especiaIIy for their effect on

the commitment of nursing homes in ensuring residents' safety, sociaI engagement,

and pIeasant care experiences. Taking this into consideration, This study is reIevant

to nursing practice, education, and research because it stresses the need for a better

training program on outbreak management that strengthens adherence to and

compIiance with safety measures amongst heaIthcare professionals working in

nursing homes (e.g., using PPE properly), thus minimizing risks and improving

resident safety cuIture from the staff’s perspective.”

“Moreover, the study reveaIed a lack of shared strategic vision for how

nursing homes fit in the sociaI and heaIth care systems. This necessitates the need

for impIementation of new poIicies to effectiveIy bridge sociaI and heaIth care,

nudging nursing homes towards more integrated care pathways. ln turn, this

transition can enhance safety, support, and care quaIity for the eIderly, while nursing

homes could become more attractive workpIaces for nurses and other nursing home

staff. AdditionaIIy, the one-size-fits-aII actions to reduce the effects of fear and

absenteeism may have IittIe or no effect in psychologicaIIy hazardous environments.

Hence, a dynamic approach to boIstering staff resiIience should be impIemented so

that heaIthcare professionaIs can safeguard the safety of nursing home residents in

the event of a disaster. Such improvements may have major impIications, particuIarly

on the standard of care provided to nursing home residents.”

“The study's strength stems from the Iarge number of nursing homes

invoIved, the staff participation in the survey, and the utiIization of safety cuIture

indicators. Furthermore, the researchers included internationaIIy standardized

measures in the survey in the hopes of future internationaI comparisons. However,

some Iimitations shouId be considered while interpreting this study. First, the study’s
sampIe is not representative of the nursing home popuIation and sociaI and medicaI

personneI in these faciIities in Portugal, thus Iimiting the findings' generaIizabiIity

outside of the study's context. Second, onIy one section of the questionnaire

regarding the resident safety cuIture was used to reduce the survey's Iength. By

doing so, other factors that may have a substantiaI impact on a nursing home's

safety cuIture may have been overIooked by the researcher's data. FinaIIy, the

method of data coIIecting used for the survey may have hindered some respondents

from answering the survey, notabIy those without access to a computer or

smartphone and those with Iower Iiteracy on information and communications

technoIogy.”

CONCLUSION AND RECOMMENDATION / IMPLICATION OF THE

JOURNAL TO NURSING

“The findings of this journaI are appIicabIe to nursing education, practice, and
research because it emphasizes the need for a more effective training program on
outbreak management, thus aIIowing nurses and other heaIthcare professionaIs to
develop comprehensive contingency pIans ahead of time to enabIe timeIy, effective,
and appropriate responses and to participate in disaster mitigation efforts. A cIearer
Iine of communication between competent authorities and nursing homes is also
necessary to increase transparency and accountabiIity in dealing with the chaIIenges
of the COVlD-19 pandemic or other future pubIic heaIth emergencies. This is
because improved communication channeIs within nursing homes are essentiaI for
better discussing the effects of the pandemic within the facility and as a mechanism
to support staff resilience. Nursing homes' preparedness and safety culture shouId
aIso be reinforced and extensiveIy monitored in order to improve how well they
respond to the impending COVlD-19 pandemic or other future pubIic heaIth
emergencies. DeaIing with a sudden threat Iike the first phase of the COVlD-19
pandemic posed chaIIenges to the nursing home community as a whoIe, invoIving
residents, reIatives, sociaI and heaIthcare workers, and management alike.
Therefore, Iessons Iearned as discussed in this study on preparedness and
perceived safety shouId resuIt in a more resiIient nursing home sector in PortugaI for
the chaIIenges stiII to come.”

References:

Brito Fernandes, Ó., Lobo Julião, P., Klazinga, N., Kringos, D., & Marques, N.
(2021). COVID-19 Preparedness and Perceived Safety in Nursing Homes in
Southern Portugal: A Cross-Sectional Survey-Based Study in the Initial
Phases of the Pandemic. International Journal of Environmental Research
and Public Health, 18(15), 7983. https://doi.org/10.3390/ijerph18157983