Date of Award

2023

Degree Type

Dissertation

Degree Name

Doctor of Philosophy in Nursing

Department

Nursing

First Advisor

Jennifer Mammen

Second Advisor

Catharina Gillsjö

Abstract

Home health care nurses were essential front line healthcare providers during the COVID-19 pandemic in the United States. Research in this area has primarily focused on the experiences of nurses in the acute and long-term care settings. This study aims to: (1) gain an understanding of the subjective experiences and perceptions of home health care nurses providing care to OAs during the COVID-19 pandemic and (2) elucidate aspects affecting the care provided to OAs during the COVID-19 pandemic.

Twenty nurses were interviewed between July 2022 and September 2022. The interviews were semi-structured and were analyzed using reflexive thematic analysis. Four main themes were generated: (1) Increased fear for others and for oneself during the COVID-19 pandemic, (2) Substantial obstacles made it harder to provide care during the COVID-19 pandemic, (3) Multiple stressors caused a diminished sense of well-being during the COVID-19 pandemic, and (4) Finding ways to get through the day.

The greatest fear nurses experienced was of infecting others (patients and family members) and oneself. This was exacerbated by limited access to personal protective equipment and patients not always complying with masking recommendations. Masking related issues resulted in the personal ethical dilemma of whether to stop the visit (putting the patient at risk) or continue the visit (putting the nurse at risk). Multiple organizational challenges and barriers, including ever changing infection control practices and lack of clear support from leadership, increased the complexity of providing care to older adults, who were often sicker and reluctant to use hospital-based care due to fear of infection. Cumulatively this translated to increased stress on home health care nurses and a diminished sense of overall well-being. Despite these unprecedented challenges, nurses developed a deeper connection with older adults and reported increased support from peers and providers that helped them to deal with the situation and continue in their roles.

These findings suggest that greater leadership support and clear infection control policies specific to home care are needed. This can assist home health care nurses to navigate the unique challenges of home-based care, provide quality care to older adults, and preserve overall personal well-being. Results from this study can inform future disaster planning for both nurses and the older adults and the development of education, training, nursing interventions and health policies to support nurses who provide care at home.

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