"Precious time together was taken away":Impact of COVID-19 restrictive measures on social needs and loneliness from the perspective of residents of nursing homes, close relatives, and volunteers

During the COVID-19 outbreak in March 2020, restrictive measures (e.g., prohibiting physical visits and group activities) were introduced in nursing homes to protect older residents. Although the importance of social contacts and social activities to fulfill social needs and avoid loneliness is known, these were challenged during the pandemic. This qualitative study specifically focused on how residents, close relatives, and volunteers in nursing homes experienced the restrictive measures in retrospect and gained insights into the impact of the restrictive measures on social needs and loneliness, and the lessons that could be learned. Thirty semi-structured, face-to-face interviews with residents and close relatives, and one online focus group with ten volunteers, were conducted. Recruitment took place at psychogeriatric and somatic units in the Northern, Eastern and Southern regions of the Netherlands and Flanders, Belgium. The interviews and focus group were transcribed verbatim, and an open, inductive approach was used for analysis. Alternative ways of social contact could not fully compensate for physical visits. Generally, participants reported that it was a difficult time, indicated by feelings of loneliness, fear, sadness, and powerlessness. A great diversity in loneliness was reported. The most important reasons for feeling lonely were missing close social contacts and social activities. The diversity in the impact of restrictive measures depended on, e.g., social needs, coping strategies, and character. Restrictive COVID-19 measures in nursing homes resulted in negative emotions and unmet social needs of residents, close relatives, and volunteers. During future outbreaks of the COVID-19 virus or another virus or bacterium, for which restrictive measures may be needed, nursing homes should actively involve residents, close relatives, and volunteers to balance safety, self-determination, and well-being

Moral lessons from residents, close relatives and volunteers about the COVID-19 restrictions in Dutch and Flemish nursing homes

BACKGROUND: During the COVID-19 outbreak in 2020, national governments took restrictive measures, such as a visitors ban, prohibition of group activities and quarantine, to protect nursing home residents against infections. As 'safety' prevailed, residents and close relatives had no choice but to accept the restrictions. Their perspectives are relevant because the policies had a major impact on them, but they were excluded from the policy decisions. In this study we looked into the moral attitudes of residents, close relatives and volunteers regarding the restrictions in retrospect, and what moral lessons they considered important.METHODS: We conducted 30 semi-structured interviews with residents and close relatives and one focus group meeting with volunteers working in nursing homes. Data were transcribed verbatim and analyzed inductively. Subsequently, three Socratic dialogue meetings with residents, close relatives and volunteers were organized in which first analysis outcomes were discussed and dialogues were fostered into moral lessons for future pandemics. Outcomes were combined with moral theory following an empirical bioethics design.RESULTS: Critical perspectives regarding the COVID-19 restrictions grew in time. Various moral values were compromised and steered moral lessons for our future. The participants recognized three moral lessons as most important. First, constructing tailored (well-balanced) solutions in practice is desirable. Second, proper recognition is needed for the caring role that close relatives fulfill in practice. Third, a responsive power distribution should be in place that includes all stakeholder perspectives who are affected by the restrictions.DISCUSSION: Comparing the results with moral theory strengthens the plea for inclusion of all stakeholder groups in decision-making processes. To further concretize the moral lessons, tailored solutions can be realized with the use of moral case deliberations. Proper recognition includes actions addressing moral repair and including counter-stories in the debate. Responsive power distribution starts with providing clear and trustworthy information and including all perspectives.</p

Moral lessons from residents, close relatives and volunteers about the COVID-19 restrictions in Dutch and Flemish nursing homes

Abstract Background During the COVID-19 outbreak in 2020, national governments took restrictive measures, such as a visitors ban, prohibition of group activities and quarantine, to protect nursing home residents against infections. As ‘safety’ prevailed, residents and close relatives had no choice but to accept the restrictions. Their perspectives are relevant because the policies had a major impact on them, but they were excluded from the policy decisions. In this study we looked into the moral attitudes of residents, close relatives and volunteers regarding the restrictions in retrospect, and what moral lessons they considered important. Methods We conducted 30 semi-structured interviews with residents and close relatives and one focus group meeting with volunteers working in nursing homes. Data were transcribed verbatim and analyzed inductively. Subsequently, three Socratic dialogue meetings with residents, close relatives and volunteers were organized in which first analysis outcomes were discussed and dialogues were fostered into moral lessons for future pandemics. Outcomes were combined with moral theory following an empirical bioethics design. Results Critical perspectives regarding the COVID-19 restrictions grew in time. Various moral values were compromised and steered moral lessons for our future. The participants recognized three moral lessons as most important. First, constructing tailored (well-balanced) solutions in practice is desirable. Second, proper recognition is needed for the caring role that close relatives fulfill in practice. Third, a responsive power distribution should be in place that includes all stakeholder perspectives who are affected by the restrictions. Discussion Comparing the results with moral theory strengthens the plea for inclusion of all stakeholder groups in decision-making processes. To further concretize the moral lessons, tailored solutions can be realized with the use of moral case deliberations. Proper recognition includes actions addressing moral repair and including counter-stories in the debate. Responsive power distribution starts with providing clear and trustworthy information and including all perspectives

Gevolgen van restrictieve maatregelen door COVID-19 uitbraak op eenzaamheid en sociale behoeften van bewoners, naasten en vrijwilligers in verpleeghuizen

Due to the (privacy) sensitive nature of the data and contractual limitations, the data are stored in a secure location at Tilburg University and cannot be shared. A codetree was created to analyse the data of this qualitative study and consists of main codes and subcodes, regarding the topics of this project. The codetree is available. Topic of the research: This qualitative study reported on the consequences of the COVID-19 restrictive measures in nursing homes, from the perspective of residents, close relatives, and volunteers. The focus was on social needs, negative consequences such as loneliness, resilience and moral judgement concerning the measures. Main research questions: 1. What was the impact of the restrictive measures on experienced loneliness and social needs of residents, close relatives, and volunteers in nursing homes? 2. Which resources were used by residents, close relatives, and volunteers to deal with the restrictive measures and what helped them to minimize the consequences of the measures? 3. How has the ban on in-person visits been judged by residents, close relatives, and volunteers in retrospect? 4. What are lessons learned

Gevolgen van restrictieve maatregelen door COVID-19 uitbraak op eenzaamheid en sociale behoeften van bewoners, naasten en vrijwilligers in verpleeghuizen

Due to the (privacy) sensitive nature of the data and contractual limitations, the data are stored in a secure location at Tilburg University and cannot be shared. A codetree was created to analyse the data of this qualitative study and consists of main codes and subcodes, regarding the topics of this project. The codetree is available. Topic of the research: This qualitative study reported on the consequences of the COVID-19 restrictive measures in nursing homes, from the perspective of residents, close relatives, and volunteers. The focus was on social needs, negative consequences such as loneliness, resilience and moral judgement concerning the measures. Main research questions: 1. What was the impact of the restrictive measures on experienced loneliness and social needs of residents, close relatives, and volunteers in nursing homes? 2. Which resources were used by residents, close relatives, and volunteers to deal with the restrictive measures and what helped them to minimize the consequences of the measures? 3. How has the ban on in-person visits been judged by residents, close relatives, and volunteers in retrospect? 4. What are lessons learned