gms | German Medical Science

Background: Nurses’ work-related strain and psychological burden increased during the Covid-19 pandemic, resulting in high prevalences of mental health problems among nurses worldwide. Nurses in long-term care facilities seem to be particularly prone to overall heightened burden and poor mental health.

Research question: We investigated which work-related psychosocial burdens and potential positive aspects nurses working in nursing homes experience during the Covid-19 pandemic.

Method: We conducted a mixed-methods study. Eligible for participation were nurses and nursing assistants working in nursing homes within the state of Brandenburg, Germany. Between August and October 2020, we distributed an anonymous survey containing the third German version of the Copenhagen Psychosocial Questionnaire (COPSOQ III). Using Welch’s t-tests, we compared the COPSOQ results of our sample against a pre-pandemic reference group of geriatric nurses, drawn from the German COPSOQ databank and kindly shared by the Freiburg Research Centre for Occupational Science. In June 2021, we also conducted semi-structured interviews with geriatric nurses to reach a deeper understanding of their experiences on work-related changes and burdens during the first phases of the pandemic. Data were analysed using thematic coding (Braun and Clarke).

Results: Our survey sample (n=177) differed significantly from the reference group in 14 out of 31 COPSOQ scales. Amongst others, our sample scored significantly worse regarding the scales ‘support at work’, ‘recognition’, ‘quantitative demands’, ‘hiding emotions’, ‘role conflicts’, ‘intention to leave profession’, ‘burnout’ and ‘inability to relax’. The interviews (n=17) revealed five main themes related to nurses’ psychosocial stress: ‘overall working conditions under the hygiene measures’, ‘concern for isolated residents’, ‘management of relatives’, ‘inability to provide terminal care‘, ‘tensions between being infected and infecting others’ and ‘technicisation of care’. ‘Enhanced community cohesion’ and ‘meaning of work’ were identified as positive effects of the pandemic.

Discussion: Results indicate that nurses in nursing homes experience enhanced psychosocial and work-related strain. The comparisons with the pre-pandemic reference group suggest that the situation further aggravated during the pandemic. Nurses exhibited high psychosocial burden, e.g., due to strongly impeded possibilities to fulfill the emotional and social dimensions of care and the constant fear of infection or transmission. Deteriorated working conditions (e.g., higher workload through staff shortages and additional tasks) further exacerbated these burdens. Few positive aspects of the pandemic may be important sources of resilience.

Practical implications: The reduction of nurses’ strain through psychosocial support and the improvement of working conditions is crucial for the protection of nurses’ health.

Appeal for practice in one sentence: Political players as well as care facilities should take measures to improve nurses’ situation in order to maintain a healthy workforce and high-quality care.