Anita Nilsen

• Nilsen, Anita; Lichtwarck, Bjørn; Eriksen, Siren & Rokstad, Anne Marie Mork (2023). Clinical expressions, characteristics and treatments of confirmed COVID-19 in nursing home residents: a systematic review. BMC Geriatrics. ISSN 1471-2318. 23, p. 1–25. doi: 10.1186/s12877-023-03826-0. Full text in Research Archive Show summary

  Background: The coronavirus 2019 (COVID-19) pandemic has led to a high rate of infections, frequent outbreaks, and high mortality rates in nursing homes (NH) worldwide. To protect and improve the treatment and care of the vulnerable NH population, it is pivotal to systematise and synthesise data from cases of COVID-19 among NH residents. In our systematic review, we therefore aimed to describe the clinical expressions, characteristics, and treatments of NH residents confirmed to have COVID-19. Methods: We conducted two comprehensive literature searches in several electronic databases: (1) PubMed, (2) CINAHL, (3) AgeLine, (4) Embase, and (5) PsycINFO in April and July 2021. Of the 438 articles screened, 19 were included in our sample, and we used the Newcastle–Ottawa Assessment Scale to assess the quality of the reported studies. A weighted mean (Mweighted), was calculated to account for the large variation in sample sizes of the studies, and due to heterogeneity among the studies, we report our findings in a narrative synthesis. Results: According to the mean weights (Mweighted), common symptoms and signs in NH residents confirmed to have COVID-19 were fever (53.7%), cough (56.5%), hypoxia (32.3%), and delirium or confusion (31.2%). Common comorbidities were hypertension (78.6%), dementia or cognitive impairment (55.3%), and cardiovascular diseases (52.0%). Six studies presented data concerning medical and pharmacological treatments, such as inhalers, oxygen supplementation, anticoagulation, and parenteral/enteral fluids or nutrition. The treatments were used to improve outcomes, as part of palliative care, or as end-of-life treatment. Transfers to hospital for NH residents with confirmed COVID-19 were reported in six of the included studies, and the rate of hospital transfers ranged from 6.9% to 50% in this population. In the 17 studies reporting mortality, 40.2% of the NH residents died during the studies’ observation periods. Conclusions: Our systematic review allowed us to summarise important clinical findings about COVID-19 among NH residents and to identify the population’s risk factors for serious illness and death caused by the disease. However, the treatment and care of NH residents with severe COVID-19 warrant further investigation.

• Julnes, Signe Gunn; Lichtwarck, Bjørn; Eriksen, Siren ; Hillestad, Adelheid Hummelvoll; Nilsen, Anita & Tretteteig, Signe [Show all 7 contributors for this article] (2022). Nursing home physicians’ experiences with Covid-19 : a qualitative interview study. Tidsskrift for omsorgsforskning. ISSN 2387-5976. 8(3), p. 1–14. doi: 10.18261/tfo.8.3.12. Full text in Research Archive Show summary

  Covid-19 affected patients were at high risk of serious events and deaths in Norwegian nursing homes during the pandemic. The objective of this study was to explore nursing home physicians’ experiences of caring for Covid-19 patients and collaborating with their informal caregivers and nurses. The study is an interview study that included ten nursing home physicians recruited from three out of four health regions with experience from Covid-19 in their nursing homes. A qualitative content analysis of the transcribed interviews was performed. The analysis identified the following categories presented as the main findings: (1) Demanding responsibility for medical assessments and decisions; (2) Communication and collaboration with family caregivers: important and time consuming; and (3) The nurses: an important collaboration partner. The responsibility and challenges in caring for multimorbid and frail patients during the pandemic was experienced as demanding. This finding illustrates the need for good routines as well as local and national guidelines. The importance of experienced nurses as working partners was emphasized. The nursing home physicians ’ description of emotional challenges emphasizes the need for permanent, collegial, and professional networks. Keywords: primary health care, pandemic, multimorbidity, elderly collaboration

• Tretteteig, Signe; Eriksen, Siren; Hillestad, Adelheid H.; Julnes, Signe Gunn; Lichtwarck, Bjørn & Nilsen, Anita [Show all 7 contributors for this article] (2022). The experience of relatives of nursing home residents with COVID-19 : a qualitative study. Nursing: Research and Reviews. 12, p. 17–27. doi: 10.2147/NRR.S328336. Full text in Research Archive Show summary

  Background: The coronavirus disease 2019 (COVID-19) pandemic had significant consequences for relatives’ opportunities to communicate with and offer care to seriously ill and dying nursing home residents with COVID-19. Residents in nursing homes were urged to protect themselves through social distancing, and visits have been permanently regulated and limited. These restrictions have been challenging, and the limitations have raised many questions and led to difficult choices. The aim of this study was to explore the experiences of relatives of nursing home residents with COVID-19. We investigated the following two research questions: How did relatives of COVID-19 patients in Norwegian nursing homes experience the situation and how did the physical distancing and precepts of infection control affect the relationship between the long-term residents and the relatives?. Methods: The study has a qualitative explorative design with a phenomenological-hermeneutic approach, with individual in-depth interviews used for data collection. The study included ten relatives of nursing home residents with COVID-19. Results: Three main perspectives were identified from the participants’ experiences: (1) the difficult choices; (2) maintaining the relationship; and (3) experiencing support. The relatives experienced ethical dilemmas when weighing the risk of getting COVID-19 if they visited the patient versus the consequences of not visiting their loved one. In this situation, they needed good information and support from health care professionals. Conclusion: To enable relatives of COVID-19 patients to make choices in line with their goals and intrinsic motivations, it is important that staff members possess competence in infection control, updated knowledge about the residents’ situations, and the skills to facilitate a safe and confident dialogue. Trust in the care staff and a feeling of safety are essential for relatives in a stressful situation with difficult choices, while a lack of confidence, routines, and/or dialogue might increase relatives’ feelings of insecurity and stress and make their caring role difficult.

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