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      COVID-19 pandemic or chaos time management: first-line worker shortage – a qualitative study in three Canadian Provinces

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          Abstract

          Background

          Over the successive waves of the COVID-19 pandemic, front-line care workers (FLCWs) —in this case, at long-term care facilities (LTCFs)— have been the backbone of the fight. The COVID-19 pandemic has disproportionately affected LTCFs in terms of the number of cases, deaths, and other morbidities, requiring managers to make rapid and profound shifts. The purpose of this study is to describe the effects of the pandemic on LTCF services offered and LTCFs staff dedicated to linguistic minorities in three Canadian provinces.

          Methods

          This qualitative descriptive study involved eleven managers and fourteen FLCWs, from six LTCFs of three Canadian provinces (New-Brunswick, Manitoba and Quebec). A qualitative content analysis was performed to identify key themes describing the effects of the COVID-19 pandemic on the services offered and the management of LTCFs staff.

          Results

          Based on participants’ experiences, we identified three main categories of themes. These macro-themes are as follows: (i) organization and management of staff, (ii) communication and decision-making method, and (iii) staff support.

          Conclusion

          The study highlighted the tremendous impact of COVID-19 on direct care staff in terms of the high risks associated with caring for LTCFs residents, which are exacerbated by absences and resignations (sometimes up to 50% of staff), resulting in higher resident to FLCWs ratios. Team members had to support each other, they also received accolades and appreciation from the residents.. Finally, the pandemic led to the rethinking of management procedures centred on a coordinated, inclusive and more hands-on management approach.

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          Most cited references15

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          Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study

          Summary Background Data for front-line health-care workers and risk of COVID-19 are limited. We sought to assess risk of COVID-19 among front-line health-care workers compared with the general community and the effect of personal protective equipment (PPE) on risk. Methods We did a prospective, observational cohort study in the UK and the USA of the general community, including front-line health-care workers, using self-reported data from the COVID Symptom Study smartphone application (app) from March 24 (UK) and March 29 (USA) to April 23, 2020. Participants were voluntary users of the app and at first use provided information on demographic factors (including age, sex, race or ethnic background, height and weight, and occupation) and medical history, and subsequently reported any COVID-19 symptoms. We used Cox proportional hazards modelling to estimate multivariate-adjusted hazard ratios (HRs) of our primary outcome, which was a positive COVID-19 test. The COVID Symptom Study app is registered with ClinicalTrials.gov, NCT04331509. Findings Among 2 035 395 community individuals and 99 795 front-line health-care workers, we recorded 5545 incident reports of a positive COVID-19 test over 34 435 272 person-days. Compared with the general community, front-line health-care workers were at increased risk for reporting a positive COVID-19 test (adjusted HR 11·61, 95% CI 10·93–12·33). To account for differences in testing frequency between front-line health-care workers and the general community and possible selection bias, an inverse probability-weighted model was used to adjust for the likelihood of receiving a COVID-19 test (adjusted HR 3·40, 95% CI 3·37–3·43). Secondary and post-hoc analyses suggested adequacy of PPE, clinical setting, and ethnic background were also important factors. Interpretation In the UK and the USA, risk of reporting a positive test for COVID-19 was increased among front-line health-care workers. Health-care systems should ensure adequate availability of PPE and develop additional strategies to protect health-care workers from COVID-19, particularly those from Black, Asian, and minority ethnic backgrounds. Additional follow-up of these observational findings is needed. Funding Zoe Global, Wellcome Trust, Engineering and Physical Sciences Research Council, National Institutes of Health Research, UK Research and Innovation, Alzheimer's Society, National Institutes of Health, National Institute for Occupational Safety and Health, and Massachusetts Consortium on Pathogen Readiness.
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            Nursing home staff networks and COVID-19

            Significance Nursing homes account for 40% of US COVID-related fatalities as of August 31, highlighting the urgent need to reduce SARS-CoV-2 transmission routes in these facilities. Our large-scale analysis of smartphone location data reports half a million individuals entering a nursing home following the March 13 federal ban on visitors. With 5.1% of these individuals entering two or more facilities, a nursing home snapshot network emerges. More connections, likely arising from contractors and staff working at multiple facilities, are highly predictive of COVID-19 cases, whereas traditional regulatory quality metrics are unimportant in predicting outbreak size. With an estimated 49% of nursing home cases attributable to cross-facility staff movement, attention to highly connected nursing facilities is warranted.
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              Social Isolation—the Other COVID-19 Threat in Nursing Homes

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                Author and article information

                Contributors
                ibeogo@uottawa.ca
                Journal
                BMC Geriatr
                BMC Geriatr
                BMC Geriatrics
                BioMed Central (London )
                1471-2318
                3 September 2022
                3 September 2022
                2022
                : 22
                : 727
                Affiliations
                [1 ]GRID grid.28046.38, ISNI 0000 0001 2182 2255, École des sciences infirmières, School of Nursing, Faculty of Health Sciences, , University of Ottawa, ; Ottawa, ON Canada
                [2 ]GRID grid.21613.37, ISNI 0000 0004 1936 9609, College of Nursing, Rady Faculty of Health Sciences, , University of Manitoba, ; Winnipeg, MB Canada
                [3 ]GRID grid.23856.3a, ISNI 0000 0004 1936 8390, Faculté des sciences de l’éducation, , Université Laval, ; Québec, Québec Canada
                [4 ]GRID grid.265705.3, ISNI 0000 0001 2112 1125, Département des sciences infirmières, , Université du Québec en Outaouais, ; Saint-Jérôme, Gatineau, Québec Canada
                [5 ]GRID grid.14848.31, ISNI 0000 0001 2292 3357, Département de médecine sociale et préventive, , École de santé publique Université de Montréal, ; Montréal, Québec Canada
                [6 ]GRID grid.265686.9, ISNI 0000 0001 2175 1792, École des hautes études publiques (HEP), , Université de Moncton, ; New Brunswick, Moncton, Canada
                [7 ]GRID grid.431497.c, ISNI 0000 0000 8655 6122, Canadian Institute for Public Health Inspectors, ; Vancouver, MB Canada
                [8 ]GRID grid.459278.5, ISNI 0000 0004 4910 4652, English Language and Cultural Communities Planning, Programming and Research Officer, , Jeffery Hale - Saint Brigid’s, CIUSSSCN, ; Québec, Canada
                [9 ]GRID grid.23856.3a, ISNI 0000 0004 1936 8390, Faculté des sciences infirmières, , Université Laval, ; Québec, Québec Canada
                [10 ]GRID grid.14848.31, ISNI 0000 0001 2292 3357, Département de Gestion, d’évaluation Et de Politique de Santé, , École de santé publique, Université de Montréal, ; Montréal, Québec Canada
                Article
                3419
                10.1186/s12877-022-03419-3
                9440325
                36057549
                4e38304a-4de9-45cd-a1f6-fa76d0043607
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 3 April 2022
                : 26 August 2022
                Categories
                Research
                Custom metadata
                © The Author(s) 2022

                Geriatric medicine
                older adults,managers,frontline workers,covid-19,canada,long-term,care facilities,nursing home,linguistic minorities

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