Crisis management and relational work in Swiss nursing homes during COVID-19: a qualitative multistakeholder study.

Introduction: The COVID-19 pandemic confronted nursing homes across countries as they sought to prevent the spread of the virus among residents, placing substantial strain on the different stakeholder groups in healthcare. This study examines how key stakeholders of nursing homes experienced and enacted pandemic governance and how these experiences shaped organisational dynamics, relational work and preparedness for future crises. Methods: An exploratory qualitative study design was used to collect data in Switzerland between August 2024 and February 2025 across ten cantons in German-speaking and French-speaking regions. 24 semistructured, in-depth interviews were conducted with stakeholders from medicine, nursing and management as well as residents' next of kin. Interviews were audio-recorded, transcribed verbatim and analysed using the Braun and Clarke six-phase thematic approach. The findings were interpreted using an epistemological approach and discussed with Joan Tronto's ethics of care in order to illuminate relational and democratic dimensions of governance. Results: Three overarching themes were identified: (1) crisis governance under sustained uncertainty, (2) organisational strain and expanded relational labour and (3) selective learning and persistent gaps in preparedness. Pandemic management was characterised by the continuous local translation of rapidly changing public health directives, decentralised responsibility and the limited usefulness of formal emergency plans. Prolonged crisis conditions led to cumulative organisational strain, increased leadership pressure and heightened relational labour, particularly in communication and negotiation with next of kin. While adaptations such as infection-control workflows, vaccination logistics and testing routines improved over time, psychosocial, interpersonal and ethical dimensions remained insufficiently integrated, resulting in a fragmented process of institutional learning. Conclusions: Pandemic preparedness in nursing homes extends beyond technical readiness and formal protocols: effective crisis management depended on relational labour and the local adaptation of general guidelines. Future preparedness should integrate relational, participatory and psychosocial capacities alongside infection prevention and control measures. Reporting method: (The Consolidated criteria for Reporting Qualitative research (COREQ) checklist was followed.).