"If we survive this, we'll make it through anything" - Exploration of the COVID-19 pandemic from the perspective of nursing home staff in Hesse, Germany.

backgroundAs the COVID-19 pandemic unfolded, nursing homes became one of its most salient settings given rapid and deadly outbreaks. This study aimed to explore the perception of the pandemic after its conclusion and its implications for the future from the perspective of nursing home (NH) staff.

methodsWe used a purposive sampling strategy to conduct semi-structured interviews with 41 members of staff with different professional backgrounds and at different hierarchical levels at three nursing homes in Hesse, Germany. Interviews were analysed using reflexive thematic analysis by Braun and Clarke.

resultsFour main themes were developed: "It's us against the world" refers to the strong sense of team spirit, mutual understanding and working towards a common purpose. This was often contrasted against the outside world of those who had not lived through the same experience. "Was it the physical or psychological burden? - Both" describes the mutually amplifying co-incidence of a high psychological burden with an exceptionally high workload in combination with critical staff shortages. "Death and dying - but not in these quantities, not in these circumstances" summarises the staff experience of death and dying, both in quantitative terms as well as qualitative terms, e.g. residents dying without their relatives, and staff not being able to support the dying process or mourn the dead. "From absolutely unprecedented to practiced routines" entails the development from a situation in which no one knew what to do, to a situation of experience and expertise. This was often linked to calls for "outsiders" to listen and learn from NHs.

conclusionsOur findings describe the subjective experience of NH staff working through the pandemic, shedding light on aspects of teamwork, workload and wellbeing, resident deaths and preparedness for future challenges. We would recommend for future research to focus on mixed methods approaches to investigate to what extent in-depth qualitative insights apply in larger samples. As practice implications, it seems relevant to establish realistic pipelines from practice experts to policy makers in inter-pandemic times, and to work towards improving general conditions in NHs as these will form the foundation for the quality of the pandemic response. STUDY REGISTRATION: German Clinical Trial Register, DRKS00030812, registration date 30.12.2022. CLINICAL TRIAL NUMBER: Not applicable.