Direct care workers (DCWs) experience job quality challenges such as heavy workload, low pay, and few benefits. Layered risks such as the COVID-19 pandemic and systemic racism have impacted DCWs, made them more vulnerable, and increased turnover and the precarity of the long-term care system and residents’ care. Drawing from qualitative interviews collected from 25 direct care workers, this study seeks to understand and describe the DCWs’ experiences of trauma during COVID-19 and how these experiences affect their ability to provide care. Findings suggest that DCWs are often crippled with challenges stemming from the impact of COVID-19, work-related factors, and personal factors. Understanding the intersection of trauma provides a detailed contextual description of care work, which is important for developing practical coping strategies, either at the personal or organizational levels, and developing more refined trauma-informed initiatives to build resilience and support DCWs.
AlisonT. A.OhA.HarrisonK. (2021). Extreme vulnerability of home care workers during the COVID-19 pandemic – a call to action. JAMA Internal Medicine, 180(11), 1459–1460. https://doi.org/10.1001/jamainternmed.2020.3937
2.
AmateauG.GendronT. L.RhodesA. (2023). Stress, strength, and respect: Viewing directcare staff experiences through a trauma-informed lens. Gerontology and Geriatrics Education. https://doi.org/10.1080/02701960.2022.2039132
3.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th Ed.). American Psychiatric Association. (DSM-5). 2013.
4.
BlancheM. T.DurrheimK.PainterD. (2006). In BlancheM. T.DurrheimK.PainterD. (Eds.), Research in practice: Applied methods for the social sciences. RSA: Juta and Company Ltd.
5.
Blanco-DonosoL. M.Moreno-JiménezJ.AmutioA.Gallego-AlbertoL.Moreno-JiménezB.GarrosaE. (2020). Stressors, job resources, fear of contagion, and secondary traumatic stress among nursing home workers in face of the COVID-19: The case of Spain. Journal of Applied Gerontology, 40(3), 244–256. https://doi.org/10.1177/0733464820964153
BurgessE. O.BenderA. A.BarmonC.MoorheadJ. M.PerkinsM. M. (2018). ‘That is So common everyday. . .Everywhere you go’: Sexual harassment of workers in assisted living. Journal of Applied Gerontology: The Official Journal of the Southern Gerontological Society, 37(4), 397–418. https://doi.org/10.1177/0733464816630635
8.
CastleN. G.HyerK.HarrisJ. A.EngbergJ. (2020). Nurse aide retention in nursing homes. The Gerontologist, 60(5), 885–895. https://doi.org/10.1093/geront/gnz168
9.
CateauD. (2021). Brush fire: COVID-19 and our nursing homes. Fulton Books.
CockerF.JossN. (2016). Compassion fatigue among healthcare, emergency and community service workers: A systematic review. International Journal of Environmental Research and Public Health, 13(6), Article 618. https://doi.org/10.3390/ijerph13060618
13.
CreswellJ. W. (2003). Research design. Qualitative, quantitative and mixed methods approaches. Sage Publications.
14.
DillJ. S.MorganJ. C.MarshallV. W.PruchnoR. (2013). Contingency, employment intentions, and retention of vulnerable low-wage workers: An examination of nursing assistants in nursing homes. The Gerontologist, 53(2), 222–234. https://doi.org/10.1093/geront/gns085
15.
DuffyM.ArmeniaA.StaceyC. L. (2015). In DuffyM.ArmeniaA.StaceyC. L. (Eds.), Caring on the clock: The complexities Moreover, contradictions of paid care work. Rutgers University Press.
16.
DugarovaE. (2020). Unpaid care work in times of the COVID-19 crisis: Gendered impacts, emerging evidence and promising policy responses. In “Families in Development: Assessing progress, challenges and emerging issues. Focus on modalities for IYF +30”. United Nations System.
17.
FrankA. W. (2010). Letting stories breathe. University of Chicago Press.
18.
FranzosaE.TsuiE. K.BaronS. (2019). “Who’s caring for us?”: Understanding and addressing the effects of emotional labor on home health aides’ well-being. The Gerontologist, 59(6), 1055–1064. https://doi.org/10.1093/geront/gny099
19.
GarciaM. A.HomanP. A.GarcíaC.BrownT. H. (2021). The color of COVID-19: Structural racism and the disproportionate impact of the pandemic on older Black and Latinx adults. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 76(3), e75–e80. https://doi.org/10.1093/geronb/gbaa114
20.
GargS.KimL.WhitakerM.O’HalloranA.CummingsC.HolsteinR.PrillM.KirleyP. D.AldenN. B.KawasakiB.Yousey-HindesK.NiccolaiL.AndersonE. J.OpenoK. P.WeigelA.MonroeM. L.RyanP.HendersonJ.ChaiS. J. (2020). Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019. MMWR. Morbidity and Mortality Weekly Report, 69(15), 458–464. https://doi.org/10.15585/mmwr.mm6915e3
21.
HamE.RicciardelliR.RodriguesN. C.HiltonN. Z.SetoM. C. (2021). Beyond workplace violence: Direct and vicarious trauma among psychiatric hospital workers. A qualitative study. Journal of Nursing Management, 30(6), 1482–1489. https://doi.org/10.1111/jonm.13420
22.
HiltonN. Z.HamE.RodriguesN. C.KirshB.ChapovalovO.SetoM. C. (2021). Contribution of critical events and chronic stressors to PTSD symptoms among psychiatric workers. Psychiatric Services (Washington, D.C.), 71(3), 221–227. https://doi.org/10.1176/appi.ps.201900226
23.
JesteD. V.SavlaG. N.ThompsonW. K.VahiaI. V.GloriosoD. K.MartinA. S.PalmerB. W.RockD.GolshanS.KraemerH. C.DeppC. A. (2013). Older age is associated with more successful aging: Role of resilience and depression. The American Journal of Psychiatry, 170(2), 188–196. https://doi.org/10.1176/appi.ajp.2012.12030386
24.
KhatutskyG.WienerJ.AndersonW.PorellF. W. (2012). Work-related injuries among certified nursing assistants working in US nursing. RTI Press. Research Report.
KusmaulN.WaldropD. P. (2015). Certified nursing assistants as frontline caregivers in nursing homes: Does trauma influence caregiving abilities?Traumatology, 21(3), 251–258. https://doi.org/10.1037/trm0000041
27.
KusmaulN.WallaceB.CheonJ.SundborgS. A. (2022). Implementation of trauma informed care in nursing home settings. Journal of the American Medical Directors Association, 23(9), 1505–1506. https://doi.org/10.1016/J.JAMDA.2022.05.023
28.
LachsM.RosenT.TeresiJ.EimickeJ.RamirezM.SilverS.PillemerK. (2013). Verbal and physical aggression directed at nursing home staff by residents. Journal of General Internal Medicine, 28(5), 660–667. https://doi.org/10.1007/s11606-012-2284-1
29.
LincolnY.GubaE. G. (1985). Naturalistic inquiry. Newbury Park, CA: Sage.
MartinA. S.DistelbergB.PalmerB. W.JesteD. V. (2015). Development of a new multidimensional individual and interpersonal resilience measure for older adults. Aging & Mental Health, 19(1), 32–45. https://doi.org/10.1080/13607863.2014.909383
32.
McAlonanG. M.LeeA. M.CheungV.CheungC.TsangK. W. T.ShamP. C.ChuaS. E.WongJ. G. W. S. (2007). Immediate and sustained psychological impact of an emerging infectious disease outbreak on health care workers. Canadian Journal of Psychiatry. Revue canadienne de psychiatrie, 52(4), 241–247. https://doi.org/10.1177/070674370705200406
33.
MorganJ. C.DillJ.KallebergA. L. (2013). The quality of healthcare jobs: Can intrinsic rewards compensate for low extrinsic rewards?Work Employment and Society, 27(5), 802–822. https://doi.org/10.1177/0950017012474707
34.
O’MalleyK. A.SullivanJ. L.MillsW.DriverJ.MoyeJ. (2023). Trauma-informed care in long-term care settings: From policy to practice. The Gerontologist, 63(5), 803–811. https://doi.org/10.1093/geront/gnac072
35.
PadgettD.. (2016). Qualitative methods in social work research (3rd ed.). SAGE Publication.
36.
PHI. (2023). Direct care workers in the United States: Key facts 2023. (PHI, Sept. 2023).
37.
ProssC.SchweitzerS. (2010). The culture of organizations dealing with trauma: Sources of work-related stress and conflict. Traumatology, 16(4), 97–108. https://doi.org/10.1177/1534765610388301
38.
RahmanM. S. (2017). The advantages and disadvantages of using qualitative and quantitative approaches and methods in language “Testing and Assessment” research: A literature review. Journal of Education and Learning, 6(1), 102–112. https://doi.org/10.5539/jel.v6n1p102
39.
RushtonC. H.BatchellerJ.SchroederK.DonohueP. (2015). Burnout and resilience among nurses practicing in high-intensity settings. American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses, 24(5), 412–420. https://doi.org/10.4037/ajcc2015291
40.
ScalesK. (2020). It’s time to care: A detailed profile of America’s direct care workforce. PHI.
41.
ScalesK.LeporeM. J. (2020). Always essential: Valuing direct care workers in long- term care. The Public Policy and Aging Report, 30(4), 1–5. https://doi.org/10.1093/ppar/praa022
42.
SmithJ. L.Hollinger-SmithL. (2015). Savoring, resilience, and psychological well-being in older adults. Aging & Mental Health, 19(3), 192–200. https://doi.org/10.1080/13607863.2014.986647
43.
SonH.LeeW. J.KimH. S.LeeK. S.YouM. (2019). Examination of hospital workers’ emotional responses to an infectious disease outbreak: Lessons from the 2015 MERS Co-V outbreak in South Korea. Disaster Medicine and Public Health Preparedness, 13(3), 504–510. https://doi.org/10.1017/dmp.2018.95
StelnickiA. M.CarletonR. N.ReichertC. (2020). Nurses’ mental health and well-being: COVID-19 impacts. Canadian Journal of Nursing Research, 52(3), 237–239. https://doi.org/10.1177/0844562120931623
46.
StoneR.WilhelmJ.BishopC. E.BryantN. S.HermerL.SquillaceM. R. (2017). Predictors of intent to leave the job among home health workers: Analysis of the national home health aide survey. The Gerontologist, 57(5), 890–899. https://doi.org/10.1093/geront/gnw075
47.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. Substance Abuse and Mental Health Services Administration. HHS Publication No. (SMA) 14-4884.
48.
Temkin-GreenerH.CenX.LiY. (2020). Nursing home staff turnover and perceived patient safety culture: Results from a national survey. The Gerontologist, 60(7), 1303–1311. https://doi.org/10.1093/geront/gnaa015
49.
UdodS.MacPheeM.WagnerJ. I.BerryL.PerchieG.ConwayA. (2021). Nurse perspectives in the emergency department: The synergy tool in workload management and work engagement. Journal of Nursing Management, 29(6), 1763–1770. https://doi.org/10.1111/jonm.13320
50.
Van der KolkB. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. The Penguin Group.
51.
WaltonA. L.RogersB. (2017). Workplace hazards faced by nursing assistants in the United States: A focused literature review. International Journal of Environmental Research and Public Health, 14(5), Article 544. https://doi.org/10.3390/ijerph14050544
52.
WenhamC.SmithJ.MorganR.Gender and COVID-19 Working Group. (2020). COVID-19: The gendered impacts of the outbreak. Lancet (London, England), 385(10277), 846–848. https://doi.org/10.1016/S0140-6736(19)32990-3
53.
WhitleyM. A.DonnellyJ. A.CowanD. T.McLaughlinS. (2022). Narratives of trauma and resilience from Street Soccer players. Qualitative Research in Sport, Exercise and Health, 14(1), 101–118. https://doi.org/10.1080/2159676x.2021.1879919
54.
YauB.VijhR.PrairieJ.McKeeG.SchwandtM. (2021). Lived experiences of frontline workers and leaders during COVID-19 outbreaks in long-term care: A qualitative study. American Journal of Infection Control, 49(8), 978–984. https://doi.org/10.1016/j.ajic.2021.03.006
55.
ZhangY. Y.HanW. L.QinW.YinH. X.ZhangC. F.KongC.WangY. L. (2018). Extent of compassion satisfaction, compassion fatigue and burnout in nursing: A meta-analysis. Journal of Nursing Management, 26(7), 810–819. https://doi.org/10.1111/jonm.12589
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