TABLE 4.
Ameliorative strategies identified by nurses for each qualitative category
| Socialization, Meaningful Activity, and Mental/Behavioral Health |
|---|
| Socialization |
| Sending cards and care packages from people with IDD to friends and loved ones |
| Telephone calls, virtual technology calls (Zoom, Facetime, and Google Duo) to maintain social connections visits through the window supplemented with telephone or virtual technology for sound |
| Use of planned visits and emergency compassion visits |
| Use of Internet for “visual awareness of what is happening outside of bubble” |
| Meaningful Activity |
| Development of new person‐centered goals, both COVID‐19 and non‐COVID‐19 based |
| Establishment and maintenance of daily home routine |
| Going on community outings at nonpeak times of day |
| Socially distanced outdoor activities and walks |
| Virtual exercise classes |
| Creation of in‐home activity program: arts, crafts, exercises, movies, gardening, singing, dancing, fancy dress |
| “Thinking outside the box”: Van rides to see new sights, outdoor holiday themed events, for example, Christmas lights or Halloween decorations, enlisting help from others to think of new activities |
| Enlisting direct support professionals who know the person with IDD well to use their knowledge of the person to help encourage participation in activities |
| Advocating with local leaders for decreased client to staff ratio at day program to allow return to program for those who need it |
| Encouraging people with IDD to return to work and activities when safe and permitted to do so |
| Mental/Behavioral Health |
| Providing emotional support and reassurance |
| Use of trauma‐informed approach for support of people with IDD during the pandemic |
| Enlisting nursing students to “virtually” visit people with IDD to promote wellness, mental health, and reduce social isolation |
| Use of stuffed animals, pillows, and weighted blankets to simulate human touch |
| Weighing an individual's risk of COVID‐19 with need for human touch |
| Consulting with behavior specialists as needed related to change in routine and challenging behavior |
| Understanding and complying with COVID‐19 guidelines |
|---|
| People with IDD |
| Educating people with IDD of protective measures taken to reduce risks of COVID‐19 |
| Routine meetings with people with IDD to review guidelines and preteach before any/all outings |
| Strong encouragement for people with IDD to receive vaccine and follow guidelines |
| Accessible education materials for people with IDD (social stories, Easy Read, and video information) |
| Regular opportunities for people to ask questions and express concerns |
| Signs posted and stickers placed on the floor as visual reminders |
| Frequent direction and redirection, verbal prompting for hand washing and social distancing |
| Step‐by‐step programs to help support people with IDD to use PPE |
| Use of social scripting emphasizing that “we are all in this together” and “we are all in the same boat” |
| Staff role modeling of adhering to guidelines |
| Enlisting family and team members to help people with IDD understand need for guidelines |
| Gradual desensitization and different choices (e.g., face shields) for adherence to masking mandates |
| 1:1 staffing for isolation, with a staff experienced with IDD |
| Staff and Families |
| Daily emails to update/remind staff of COVID‐19 guidelines |
| Virtual meetings with staff (Zoom, Facetime) for staff education about guidelines |
| Reviewing guidelines, in clear and concise writing, with families and staff to promote understanding |
| Enlisting support of agency physicians and nurse practitioners to re‐inforce COVID‐19 guidelines with families and staff |
| 24/7 COVID‐19 hotline for staff calls related to COVID‐19 questions/reporting of cases |
| Designated COVID Compliance person at facility/residence to remind staff to adhere to guidelines |
| Daily monitoring of staff signs and symptoms of COVID‐19 with referral to testing as needed |
| Reviewing guidelines, in writing, with families and staff to promote understanding |
| Use of risk tools with communication of results to staff/families |
| Encouraging people to keep person with IDD home from programs if guidelines are not being followed |
| Requiring negative COVID‐19 test for participants to return to residence from families who do not comply with guidelines |
| State/regional nurse telephone call to every agency reporting a case of COVID‐19 with follow‐up email of listing of state and private resources and Powerpoint presentation on COVID‐19 and infection control for education of people with IDD and staff |
| Modifying the Environment |
| Implementing regular intervals for hand washing and sanitation |
| Repurposing different areas of buildings to use to enhance social distancing |
| Use of new homes as surge homes to keep people who have been recently discharged or had diagnostic procedures separate from medically frail people |
| Rotating free time out of room for each person with IDD in the residence |
| Staggered mealtimes to promote social distancing |
| Access, quality, and continuity of care and support |
|---|
| Access to and quality of health care |
| Advocating for same level of care as person without IDD in mainstream care settings by discussing duty to care with health care providers |
| Training staff to advocate for people with IDD in health care settings |
| Educating local health care facilities on how to care for and support people with IDD |
| Educating local public health department about pandemic‐related needs of people with IDD |
| Changing health care providers to those willing to provide care |
| Requesting first or last appointment of the day for people with IDD unable to wear masks/socially distance |
| Evaluate importance and appropriateness of face‐to‐face appointments on ongoing basis |
| Use of telehealth for primary care appointments, as appropriate based on person's needs and risks |
| Use of urgent care when health care provider refuses needed face to face visit |
| Defer to primary care provider/general practitioner for specialist care, like eye exams, in the case of care refusal by specialist |
| Working with national groups to elevate people with IDD in prioritization for care |
| Access to vaccination |
| Liaising with individual's general providers to obtain vaccine |
| Use of drive‐up vaccination clinics |
| Collaboration with local and state health departments to form a vaccine team to vaccinate people with IDD in group homes and residential settings |
| Access to and quality of disability direct support |
| Hiring more staff and shifting day staff into residences while day programs closed to meet increased staffing needs due to more people remaining home |
| Virtual job fairs and referral bonuses |
| Incentive pay to retain existing direct support staff |
| Emotional support of existing staff using frequent phone calls to the sites, asking how the staff is in addition to the people they are supporting, listening to them, answering questions and encouraging they reach out when needed, acknowledging that this is a difficult time, providing EAP [employee assistance program] phone number. |
| Improved shift to shift communication so no shift is left feeling unsupported |
| Holding staff accountable for coming into work when knowingly symptomatic or exposed to COVID‐19 |
| Supporting families to seek disability support from family/friends in the absence of formal supports |
| Identifying staff who had COVID or were COVID positive and reaching out to them to assist homes that were experiencing a COVID crisis. If staff are willing, they help at homes that have COVID. |
| Use of volunteers to prep meals and drop them off at homes to make meal times easier and bring needed supplies to homes to decrease the burden on staff in homes |
| Access to and quality of disability nursing support |
| Hiring nurses new to IDD but with considerable nursing experience |
| Frequent communication and collaboration with DSPs [disability support persons] to be “nurse's eyes and ears” |
| Emotional support for the DSP |
| Meeting people outside for nurse visits to meet regulations for nursing supervision |
| Development of pandemic plans early in pandemic for future surges |
| Liaising with state/regional IDD nurse for support |
| Seeking out community of practice of other IDD nurses for support |
| Encouraging people to stay home from programs if guidelines are not being followed |
| Use of dynamic risk tools to prioritize work |
| Staying up to date on guidelines by checking CDC website daily |
| Participating in online COVID‐19 education webinars for nurses |
| Access to PPE |
| Change PPE suppliers who will provide consistent supply without raising price |
| Use of reusable gloves for cleaning tasks rather than disposable gloves |
| Applying for grants, emergency funding assistance and community donations to purchase PPE |
| Continuity of Care |
| Use of patient portal information and multiple calls/messages for updates on hospitalized person's condition |
| Using virtual technology to check in on people with IDD when nurse is prevented from visiting face‐to‐face, including when person is in acute or subacute care |
| Use of ICN to assist with coordination of medical and vaccination visits |
| Linking person to available service providers in the area |
| Support families to go outside of formal care network for assistance |
| Supporting families to seek disability support from family/friends in the absence of formal supports |
| Identifying staff who had COVID or were COVID positive and reaching out to them to assist homes that were experiencing a COVID crisis. If staff are willing, they help at homes that have COVID. |
| Volunteers that were not allowed into homes would prep meals and drop them off at homes to make meal times easier. Would also get supplies when homes were low if requested to decrease burden on staff in homes. |
| COVID‐19 fatigue and the influence of time |
|---|
| Ongoing re‐education and retraining |
| Ongoing nurse role modeling and demonstration of adhering to COVID‐19 guidelines |
| Employee surveillance |
| Providing various types of mask to minimize masking fatigue |
| Encouragement: “We are almost through this” |
| Reminding people in a friendly manner of COVID safe practices |
| Presenting factual information in a variety of ways from factual sources |
| Posters and reminders about guidelines on display |
| Use of checklists |
| Regular discussion about COVID safe practices at staff meetings |