Psychosocial Distress Among Certified Nursing Assistants in Long-Term Care During the COVID-19 Pandemic: A Social Ecological Model Informed Scoping Review

ABSTRACT

Objectives

This scoping review maps the literature on psychosocial distress and coping among nursing assistants (CNAs) in long-term care facilities (LTC) during the COVID-19 pandemic onto the Social Ecological Model (SEM) of Occupational Stress.

Methods

Searches yielded 862 unique studies. Inclusion criteria were sample CNAs or equivalent in LTC; includes psychosocial variable; and collect data from February 2020–. A multi-phasic, meta-synthesis was used to synthesize qualitative data.

Results

We identified 20 studies (13 quantitative, 7 qualitative) conducted between March 2020 and December 2021 from 14 countries. Prevalence rates were reported for perceived stress (31–33%; n = 1 study), post-traumatic stress (42%; n = 1), anxiety (53%; n = 1), depression (15–59%; n = 2), suicidal thoughts (11–15%; n = 1), and everyday emotional burnout (28%; n = 1). Qualitative studies identified factors contributing to psychosocial distress and coping at each SEM level (i.e. individual, microsystem, organization, and peri-/extra-organizational). Quantitative studies primarily measured factors relating to psychosocial distress and coping at the individual and organizational levels.

Conclusions & Clinical Implications

This review identifies specific targets for intervention for psychosocial distress among CNAs in LTC at multiple levels, including job clarity; workload; facility culture; community relations; and policy. These intervention targets remain relevant to the LTC industry beyond the context of the COVID-19 pandemic.

KEYWORDS:

• Certified nursing assistants
• COVID-19 pandemic
• long-term care
• nurse aides
• psychosocial distress

Acknowledgments

Evan Plys is supported by the National Institute on Aging under grant #K23AG078410; Ana-Maria Vranceanu is supported by the National Institute Center for Complementary and Integrative Health under grant #K24AT011760; E-Shien Chang is supported by the National Institute on Aging under grant # K01AG081540.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Clinical implications

• Multi-level interventions that account for individual, interpersonal, organizational, and societal contributors to psychosocial distress and coping may be optimal for certified nursing assistants and equivalent workers globally working in long-term care settings.

• This review identified the following areas as potential targets for multi-level intervention: clarity of job roles, responsibilities, and competencies; workload and time pressure; team and organization culture; public image and community relations; and policy and advocacy.

• Geropsychologists should consider partnering with relevant long-term care organizational reform, policy, and advocacy initiatives (e.g., Moving Forward Coalition, National Association of Health Care Assistants) to develop or align psychosocial interventions with nursing assistants.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/07317115.2024.2337137

Additional information

Funding

The work was supported by the National Center for Complementary and Integrative Health [K24AT011760]; National Institute on Aging [K01AG081540, K23AG078410].