Helsepersonells erfaringer med arbeid i sykehjem under Covid-19 pandemien: En fokusgruppe studie

Abstract

Sammendrag Utbruddet av Covid-19 pandemien våren 2020 i Norge førte behov for en stor omstilling i norske helsetjenester. Institusjoner som sykehjem måtte raskt endre rutiner for å unngå smittespredning blant ansatte, men også for å beskytte og ivareta omsorg for pasientene. Denne studien hadde som formål å få innsikt i helsepersonellets erfaringer med å arbeide i norske sykehjem under Covid-19 pandemien med tanke på å ivareta og opprettholde kvaliteten innen omsorg og hensynet til smittevernet.

Studien har en kvalitativ tilnærming med semistrukturerte fokusgruppeintervjuer for innsamling av data. Det ble gjennomført fire fokusgruppeintervjuer ved fire ulike sykehjem med henholdsvis 3-4 informanter per gruppe. Dataene ble så transkribert og analysert ved brukt av Malteruds systematiske tekstkondenserings. Sykepleiere, helsefagarbeidere og en vernepleier er representert i studien. Intervjuene fokuserte på helsepersonellets erfaringer og opplevelser med håndteringen av pandemien i deres avdeling. Hva de ansatte opplevde som utfordringer og ulike tilpasninger som ble gjort.

Funnene viser til fem hovedtemaer:  Opplevelse av samhold og støtte  Bekymring for å bringe Covid-19 inn til sine enheter  Vanskelig å henge med når det stadig kommer mye regler og retningslinjer  Pandemien påvirker kvaliteten på omsorgen til pasientene  Utfordrende å ha god kontakt med pårørende

Funnene viser at for å håndtere utfordringer og nye ukjente situasjoner så er man avhengig av et samhold med kollegaer og en støttende og trygg leder. Informasjonsflyt og samarbeid med pårørende var det som kom frem som noen av de største utfordringene for helsepersonellet. Samtidig var det en sterk frykt blant helsepersonellet for å bringe Covid-19 inn til sine enheter og arbeidsplasser. Funnene ble diskutert opp imot teorier om kvalitet og resiliens i helsetjenesten. Studien finner at helsepersonell gjorde en rekke tilpasninger for å ivareta både omsorg og smittevern under pandemien, og finner betydningen av samhold og støtte for å ivareta den adaptive kapasiteten over tid. Resiliens teorien har blitt brukt for å forklare de ulike tilpasningene helsepersonellet gjorde. Det viser seg at helsepersonellet anvendte flere resiliens strategier, men uten å være klar over dette selv.

Studien konkluderer med at samhold og støtte som buffer er en essensielt for helsepersonellet. Ved å sikre god støtte for helsepersonellet, sørger man også for å opprettholde god og trygg kvalitet på helsetjenesten. Studien viser også til at å jobbe som helsepersonell på sykehjem i en pandemi, griper inn i privatlivet til helsepersonellet grunnet frykt for å smitte pasientene som er i risikogruppen. Stikkord: Covid-19, sykehjem, helsepersonell, tilpasninger, resiliens i helsetjenesten, kvalitativ studie

Abstract The outbreak of the Covid-19 pandemic in Norway at the beginning of 2020 led to a need for significant modifications and adjustments in the Norwegian healthcare service. Institutions like nursing homes were in need of a rapid update in their routines - to prevent staff from being infected whilst continuing to offer top class protecting to their patients.

The goal of this study was to get an insight into the experience of healthcare professionals working within the Norwegian nursing homes during the Covid-19 pandemic. The main focus was on how quality was delivered in parallel with care, whilst upholding strict infection prevention measures.

This study was based on qualitative analysis of focus group interviews with open-ended questions. This was achieved with input from interview groups at four different nursing homes, with typically 3 – 4 contributors in each group. The data was then transcribed and analysed with the help of the Malteruds STC (Systematic Text Condensation). Nurses, healthcare workers and a social worker are represented in this study. The interviews focused on the experiences of healthcare workers and how they handled the pandemic in their different departments. The study covered the challenges and adaptations that the healthcare workers implemented.

The findings can be primarily condensed into the following five main categories:  A sense of unity and support.  Concerns around bringing Covid-19 into the wards that the healthcare workers are responsible for.  Difficulties of keeping track of the ever-changing rules and reporting lines, along with the associated complications of implementing these rules in practice.  How the pandemic influenced the quality of care given to the patients.  The challenges of keeping good dialogue with the next of kin.

The findings showed that to manage the challenges and unknown situations, we are dependant on the support of colleagues and the strong leadership and guidance of our own management teams. Cooperation with the next of kin and the information flow towards them was what transpired to be one of the biggest challenges for healthcare workers. The fear of brining Covid-19 into the wards and workplaces was also an overarching fear. The findings have been discussed in relation to the theories on quality and resilience in the Norwegian health service. The study finds that our health workers have done a number of adjustments and adaptions to accommodate for both care and infection control during the pandemic, and we find the importance of unity and support when it comes to the ability to adapt over time. The resilience theory has been used to explain the different adaptations that healthcare workers have made, and it is also shown that the health workers have applied these different resilience strategies without explicitly knowing that they had done so.

The study concludes that unity and support as buffer is essential for health workers. By ensuring that good support is delivered to health workers, it is also found that a high quality service within the health system is delivered to the patients. The study also shows that working as a health service provider (in a nursing home in the midst of a pandemic) can also result in negative consequences to the private lives of these workers. This happens because of the ever-present fear of infecting the very people that the health service workers are trying to protect - patients that are situated in the high risk factor groups

Key words: Covid-19, nursing homes, healthcare workers, adaption, resilience in the health service, qualitative study.