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Residents living in nursing homes or residential care facilities use common dining and activity spaces and may share rooms, which increases the risk for transmission of COVID-19 infection. This document describes key patient safety challenges facing older adults living in these settings, who are particularly vulnerable to the effects of the virus, and identifies federal guidelines and resources related to COVID-19 prevention and mitigation in long-term care. As of April 13, 2020, the Associated
Osei-Poku G, Szczerepa O, Potter A, et al. Patient Safety. 2021;3:6-17.
This mixed-methods study examined the experiences of home healthcare workers in Massachusetts during the COVID-19 pandemic. Participating home care workers noted that the lack of necessary resources (e.g., PPE, testing) and insufficient guidance specific to home care settings made their working conditions feel unsafe.
Parush A, Wacht O, Gomes R, et al. J Med Internet Res. 2020;22:e19947.
This study surveyed healthcare professionals in Israel and Portugal to identify key human factors that influence the use of personal protective equipment (PPE) when caring for patients with suspected or confirmed COVID-19. Respondents attributed difficulties in wearing PPE to discomfort, challenges in hearing and seeing, and doffing. Analyses also found an association between PPE discomfort and situational awareness, but this association reflected difficulties in communication (e.g., hearing and understanding speech).
Dzau VJ, Kirch D, Nasca TJ. N Engl J Med. 2020;383:513-515.
This commentary discusses the ongoing impact of COVID-19 on the physical, emotional, and mental health on the healthcare workforce and outlines five high-priority actions at the organizational- and national level to protect the health and wellbeing of the healthcare workforce during and after the pandemic.  
Chuang E, Cuartas PA, Powell T, et al. AJOB Empir Bioeth. 2020;11:148-159.
Before the emergence of COVID-19, the National Academy of Medicine had provided guidance on the reallocation of scarce medical resources – including ventilators – during extreme situations. Based on focus groups and key informant interviews conducted in 2018, this study sought to understand potential barriers arising from ethical conflicts to the implementation of these guidelines for ventilator allocation in the event of resource scarcity. Participants anticipated challenges reconciling this protocol with their roles and identities as health care providers, as well as concerns about emotional consequences, and fear of legal repercussions. These concerns raise questions about the performance of such a protocol in disaster scenarios and highlight the need for disaster preparedness drills and training.

Ellis B, Hicken M. CNN. May 14, 2020.

Long-term care and skilled nursing facilities care for a patient population particularly vulnerable to COVID-19 infection. This article discusses an analysis of a large nursing home system and gaps in its workforce safety program. Problems highlighted included communication practices that fall short of what is needed to assure staff safety as they care for nursing home residents.