Qualitative Insights on Diverse Impacts of Interprofessional Relationships in Nursing Homes

Background: Preventable nursing home (NH) resident hospitalization remains a critical public health issue. Studies found that improved interprofessional relationships may help reduce preventable resident hospitalizations, yet there is limited research on how different traits of relationships and communication may affect hospitalization decisions. Moreover, understanding perceived changes of work practices and interprofessional relationships of NH nurses due to COVID-19 may help to address future health emergencies. In this thesis, two exploratory, descriptive qualitative studies were conducted to understand NH nurses’ perspectives on: (1) perceived relationship between the different characteristics of interprofessional relationships and resident outcomes and (2) perceived impact of the COVID-19 pandemic on NH nurses’ work and interprofessional relationships. Methods: In the first study, two focus group (FG) sessions were conducted with 14 nurses (N=9, N=5) in June and December 2018 in two Chicagoland NHs. Three FGs were conducted in two Chicagoland NHs in the second study (one in June 2022 with nurses (N=10) in facility 1 and the second in October 2022 with nurses (N=3, N=2) in facility 2). All focus group sessions were transcribed, coded, and analyzed for shared themes and topics with the qualitative description method. Results: In the first study, nurse participants described their roles to be important in hospitalization decisions, yet perceived level of influence varied by the individual characteristics of other providers. Such perceived differences in roles, quality and pattern of communication, and use of emotions may affect nurse-provider relationships, which may also influence preventable resident hospitalizations. In the second study, nurses mentioned heavier workloads from the COVID-19 pandemic (e.g., infection control). Although participants’ interprofessional relationships and communication with other providers and nurses were found not to be negatively affected by the pandemic, some perceived challenges in interprofessional interactions with the NH administrators and leadership. Conclusions: Interprofessional factors may influence NH hospitalization decisions and preventable hospitalizations of NH residents may be more effectively reduced when these factors are targeted. During the COVID-19 pandemic, NH nurses perceived different work challenges, and mentioned positive and negative changes in their interprofessional relationships with different NH staff members (e.g., other providers and nurses versus NH administrators).