Number and length of open-ended responses.

ObjectivesTo explore experiences of U.S. (United States) nursing home leadership during the COVID-19 pandemic in their efforts to address resident loneliness and social isolation and to elicit stories about personal and professional impacts on themselves and staff.DesignQualitative inquiry via three optional open-ended questions appended to a national self-administered survey of American nursing home leaders was employed. Textual data was analyzed using an iterative reflexive thematic approach.Setting and participantsA stratified sample frame defined by facility size (beds: 30–99, 100+) and quality ratings (1, 2–4, 5) was employed. Web survey links and paper surveys were sent to 1,676 nursing home directors of nursing between February and May 2022.ResultsOpen text responses were collected from 271 nursing homes. Broad themes included: 1) Addressing needs of residents & families; 2) Challenges; and 3) Personal experiences of nursing home leadership/staff. Respondents described trauma to residents, staff, and leadership. Resident loneliness was addressed using existing and newer technologies and innovative indoor and outdoor activities. Residents experienced fear, illness, loss, and sometimes death. Isolation from family and lack of touch were particularly difficult. Regulations were seen as punitive while ignoring emotional needs of residents. Staffing challenges and pressures to do more with less created additional stress. Leadership and staff made significant sacrifices resulting in physical, social, and emotional consequences. Beneficial outcomes included staff bonding, professional growth, and permanent implementation of new interventions.Conclusions and implicationsNew and creative interventions were successfully implemented to address social isolation and loneliness. Improved Wi-Fi and other nursing home infrastructure upgrades are needed to maintain them. Reimagining often conflicting overlapping federal, state, and local regulations, grounding them in good clinical judgement, and incentivizing performance improvement should be considered. Trauma experienced by staff needs to be addressed to deal with current and future workforce needs.

研究目标：旨在探究美国养老院管理者在新冠疫情（COVID-19 pandemic）期间，为应对住客孤独与社交隔离所开展的实践经历，并征集有关管理者自身及员工所承受的个人与职业层面影响的叙事内容。
研究设计：本研究采用质性研究（qualitative inquiry）方法，在面向美国养老院管理者的全国性自填式调查问卷（self-administered survey）中附加三道可选开放式问题（open-ended questions），并通过迭代反思性主题分析法（iterative reflexive thematic approach）对采集到的文本数据进行分析。
研究对象与场景：本研究采用分层抽样框架（stratified sample frame），以机构规模（床位：30~99张、100张及以上）与质量评级（1星、2~4星、5星）作为分层依据。2022年2月至5月期间，向1676名养老院护理主管发放网络问卷链接与纸质问卷。
研究结果：共回收271家养老院的开放式文本回复。核心主题涵盖三大类：1）满足住客与家属的需求；2）面临的挑战；3）养老院管理者与员工的个人经历。受访者提及住客、员工及管理者均遭受了创伤。养老院通过现有技术与新兴技术，以及创新性的室内外活动来应对住客孤独问题。住客们经历了恐惧、患病、失去亲友乃至死亡；与家人的物理隔离以及无法获得肢体接触的状况尤其令人痛苦。相关监管政策被认为具有惩罚性，却忽视了住客的情感需求。人员配置困境以及“以更少资源完成更多工作”的压力进一步加重了工作负担。管理者与员工做出了重大牺牲，进而产生了生理、社交与情感层面的不良影响。积极成果则包括员工团队凝聚力提升、职业成长，以及新干预措施的永久落地实施。
研究结论与启示：本研究成功落地了新型创新性干预措施以缓解社交隔离与孤独问题，但需升级无线网络等养老院基础设施，以保障这些措施的持续推行。此外，应重新审视时常存在冲突与重叠的联邦、州及地方层级的监管政策，将其建立在良好的临床判断基础之上，并考虑对绩效改进行为予以激励。同时，需关注员工所遭受的创伤，以满足当前及未来的劳动力队伍需求。