Using thematic analysis, we identified four themes common to their reported experiences. These themes were: 1) “we are proud” 2) “we felt anxious” 3) “we grew closer together”, and 4) “the vaccines help”. Each theme is further divided into subthemes; Table 2 outlines this.
Table 2: Common Themes of LTC Staff Experience During a COVID-19 Outbreak
Theme
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Subthemes
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“We are proud”
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Resilience, growing stronger
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Passion for their role
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“We felt anxious”
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Safety & safety protocols
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Resident mental health
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“We grew closer together”
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Residents
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Staff
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“The vaccines help”
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Protection against outbreak & increased confidence for safety
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Return to old routines
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Hearing the voices of staff provided an opportunity to document their perspectives. In focus groups and interviews, the staff candidly shared their narratives and were keen to have their stories heard, often endeavoring to represent the views of their team. They had lots to say about the challenges they faced, their personal experiences – both the positive and the painful, and the supports that helped. In our results, we expand on these themes by focusing on quotes from interview participants.
“We are proud”
Resilience, growing stronger
The staff expressed pride in their resilience amidst tough times. They felt proud for stepping up to the challenge, taking ownership of their duties, and persevering. Growing stronger and feeling prepared to tackle future hardships were common themes evidenced by the following participant quotes.
Well, we lost a lot of lives … but we always think about the brighter side. At least I do. This is something we can’t control. We just do what we have to and whatever happens, it’s a good experience for us. I feel sorry for those who lost their lives and their families, but life must go on. We’re still standing up. And I think, standing stronger now! (Participant 3)
It’s exhausting … [but] it was a good experience and if anything comes up, we are prepared! That’s what we can say. We are prepared to face any challenge. (Participant 9)
Interestingly, these participants used the language “a good experience” to refer to the outbreak. This reflects how staff reframed this ordeal into a learning experience as a way to cope with stressors, and as a source of empowerment to keep going.
Passion for their role
Participants displayed passion for their work, reflecting on the sense of purpose they derived from serving the residents. They took pride in their efforts in caring for the residents coming to fruition, especially when witnessing the recovery of previously COVID-positive residents.
Knowing them all, I was quite touched when I saw [the residents] starting to go out of their rooms and those patients who were positive… We thought they really couldn’t make it. Now, they’re out in the dining room being their normal selves again. It’s quite rewarding! ... It’s a really nice feeling thinking about how hard we worked for them, and [how] it actually worked …
… I always tell my coworkers, especially the care aides, “we signed up for this job”. This is actual nursing! Before the pandemic, we just thought “it’s good pay, we have job openings,” that’s why I took nursing. But right now? It’s a passion ... Because sometimes we get burnt out, right? So busy, and here’s the supervisor being bossy to us, “Do this and that.” But we signed up for this. It’s like the army, but now you go to war. It’s the real deal. (Participant 3)
I was the one who discovered [this resident] with a very warm temperature. We did the swabbing and found that she was positive. She went to the hospital and came back. We did our proper PPE, I fed her in her room, gave her medications … always made sure she was eating and drinking, and she was all good! ...
… the whole time, I was on her wing and I care for her up to this day! (Participant 2)
Evidently, staff were passionate and continue to be proud of the work they do. They displayed a desire to tell their stories, with many expressing gratitude at the end of interviews for the opportunity to share their experiences. They spoke with conviction about their roles and wish to celebrate their work.
“We felt anxious”
Safety & safety protocols
Psychological stress from the possibility of contracting or spreading COVID-19 was common amongst participants. Additionally, routine tasks such as mealtimes came with the added responsibilities of safety procedures such as changing Personal Protective Equipment (PPE) every time they entered and exited a resident’s room. Staff members spent considerable energy to meet these demands.
It’s like we had a fear inside because we have families too, and other residents. (Participant 8)
On feeding a COVID-positive patient: I tried to make sure I did everything right… But sometimes they cough or spit a little bit. There are some things we can’t avoid - like if they cough, I can’t just run away. So I just move back or to the side a little. Sometimes, it’s bit scary to some of us. But we have lots of PPE available and we just make sure to follow the procedures. (Participant 6)
Contrastingly, there were participants who were not as worried about personal safety. This finding is surprising but revealing. It exposes this instinctual tendency of many frontline staff: care for residents first, think about personal consequences later.
We are not really scared of getting the virus from the residents because we know our unit is good with preventing it. I’m not worried. I’m worried about myself giving it to [residents], that is the only worry I have. (Participant 10)
I feel confident with the PPEs and the teaching that was done but I also have an attitude that worrying about getting sick or about getting something doesn’t help me. I don’t live my life worrying about how I might get ill. (Participant 21)
In either case, infectious disease education and availability of PPE/resources raised confidence to work safely. Participants indicated that they felt supported by these provisions.
Everyone was anxious and scared ... but the infection control team was really good and gave us an in-service about what COVID is, how it spreads, and how we can protect ourselves by wearing proper PPE … they convinced us we’re protected. That gave us a little confidence and we learned a lot, going through the difficult situation. (Participant 9)
Resident mental health
Participants chronicled the heartache of watching the residents’ mental health decline. During the outbreak, residents were required to stay in their rooms and forgo activities such as having meals and coffee in dining rooms or going for walks around the facility. Staff saw the effects that social isolation and disruption of routines had on the residents – many of them distressed, confused and lonely. Comforting residents of varying cognitive abilities proved challenging.
I’ve had residents tell me they feel like a prisoner, like “What did I do wrong?” You try to explain to them, “No, you didn’t do anything wrong.” I remember one resident in the beginning, long before the outbreak happened. He was sitting by the window one day and goes, “Is this virus still out there?” and I go, “yeah, unfortunately it’s still out there,” and he goes, “But I can’t see anything!” That just broke my heart …
… It was very stressful. I would leave there some days with my heart broken because I’m thinking of these poor people. They’re stuck in a 5 by 5-foot room, and I could leave there and had freedom where they didn’t have freedom. (Participant 4)
One of our Chinese resident’s son used to come take her out … She was telling [my co-worker] “My son left me here! He is not coming to see me.” She was trying to explain to her that it’s because of this virus and once it’s over, she can see go and her son. But then she would forget …Then she keeps repeating the same thing over and over. (Participant 18)
… There was one resident who had a roommate … And the roommate passed away because they were COVID-positive. Later on, they got really depressed. It was really hard to see. They were just waiting, “When am I going? What’s happening to me?” They need more encouragement, so you talk to them… You have to make them feel better. (Participant 5)
Empathy is evident in the staff’s voices. While empathy is a requisite for comforting residents, it often comes at a cost to their own wellbeing. Despite the stressors related to safety and mental health, they consistently showed compassion to residents.
“We grew closer to residents and staff members”
Residents
Staff members felt that relationships with residents grew stronger. Many participants attributed this to the extra staffing provided during the outbreak, which enabled more one-on-one time with residents.
More staff makes everything smoother and everything worked well, everybody was taken care of. We had more time to interact with the residents… (Participant 2)
I noticed [that] when I have time to talk to them, they will tell me the story of their life or something and it’s really interesting. They really want to talk. Some of them really want to listen to music, different types of music! (Participant 5)
Mealtimes were an important time of socialization. Prior to the pandemic, loved ones often visited to help feed the residents, but this responsibility fell on the staff during the outbreak. They helped fill social gaps from absence of family, volunteers, and other resident interactions. These interactions provided opportunities to get to know the residents in ways that they previously did not have before.
Some of the residents’ families always used to come to feed - but [now] we had the chance to feed them. Now we know them more and feel more attached to them. (Participant 3)
One of my residents, he likes to talk. I go in in the morning, we have breakfast, and he usually asks me “How does it look outside?” I open the curtain and tell him it’s a nice day, or it’s rainy. He says, “I can’t go out?” and I say “Not for now.” so I just hold his hand, or he has a cellphone [to] call his wife or daughter. We have to make them comfortable, right? (Participant 8)
We go in the room and talk about the food. For the drinks, like “You have your cocktail here! Why don’t you take some?” and they drink it! And for the medication, like “Okay, here’s your chocolate!” and it’s so funny! Just to keep them going, right? (Participant 2)
Working in a multicultural facility, staff members found that using residents’ own languages and culture to connect was an effective way to boost their spirits and put them at ease. One participant talked about their attempts to learn the language of the residents; another talked about connecting staff and residents with similar backgrounds.
I don’t speak the language, but I try to learn a few words of Cantonese. That puts joy on the residents’ face ... I’d put on a Chinese drama in Cantonese language or music – you see that they enjoy it …
… There’s just things that are important [to] learn, like the word for water … (Participant 11)
If we have non-English speaking residents, we try to engage them with staff that speaks that language. It really helps …There used to be a resident and when this staff member came to feed her, she would eat everything ... These things do make a difference. (Participant 9)
Staff members
Similarly, staff members grew closer to one another. Keeping the same people on each unit during the outbreak helped build community. They mentioned having daily team meetings where they shared their experiences and the strategies that worked for them that day. There was a sense of solidarity to provide the best, safest care possible while looking out for one another.
If you worked in one unit, you couldn’t work in another unit because of the outbreak. [And] we were working more. We’d work more shifts. That made the team close! (Participant 29)
The nurses would never [use to] talk - like on your shift exchange, you just see people and go. [But now] we get to see them more. And the staff, we would laugh at jokes, and if someone was in a room and couldn’t come out because of PPE we would say “Okay, no worries, just call me and I’ll bring you everything.” (Participant 22)
Before, care aides and nurses had conflict. But right now, we’re like “Don’t think about that, we have to do this!” We have to help each other. (Participant 3)
Staff members felt that the strengthened connections with residents and other staff members was a main positive outcome. They described the heightened level of teamwork as crucial to their success. Many emphasized that the extra staffing provided was a helpful support that made work more efficient and enabled more one-on-one time with residents.
“The vaccines help”
Protection against outbreak & increased confidence for safety
This facility was amongst the first in their jurisdiction to receive vaccinations. At the onset of the outbreak, the majority of staff and residents were recently immunized. Some staff believe the vaccine helped cushion the effects of the outbreak since they mostly observed mild illness and kept the outbreak relatively well-controlled.
I heard from some of my coworkers that it’s really helping. Because some unfortunately got COVID and she said that if she didn’t have the first vaccination, then maybe it would be worse. She overcame the whole process of recovering …
… I think [the vaccine helped the residents] … because up to the time we discovered the last case, we maintained that number and didn’t have more after that… [and] they were mild. Of course, we had a few pass away, but I think it’s because they had other health issues. (Participant 26)
Having most residents and staff members immunized helped staff members feel safer to work.
In your head, you have peace of mind that you’re protected already ...
… We all had a first dose, the residents and us. It gives you confidence… (Participant 8)
Starting to see return to old routines
With the protection of the vaccines, the facility started to see a return to old routines once the outbreak ended, such as permitting residents to leave their rooms and allowing for some family visits. This came as a relief to many residents after spending over a month confined to their rooms and was a positive and important step by staff towards a return to normalcy.
[Since] this Monday, we were all clear! … It’s an absolutely different environment ... [Residents] say “Can I go out now?” and they say “Really?” Some of them can’t believe it! Already now we are permitting some family to come. (Participant 15)