Challenges and Prospects for Preventing the COVID-19 Pandemic in Nursing Homes in Taiwan: A Mixed-Methods Study

During the COVID-19 pandemic, residents of Taiwanese nursing homes, many of whom suffered from chronic illnesses and lived in relatively enclosed environments, were particularly vulnerable to infection. The absence of clear and effective pandemic prevention strategies hindered the development of related risk-reduction policies and planning within these institutions.

The aim of this study was to: (1) explore the challenges and prospects related to COVID-19 pandemic prevention in nursing homes in Taiwan and offer recommendations for the future, (2) evaluate the effectiveness of the prevention strategies implemented across nursing homes of various types and scales, and (3) assess the need for pandemic-related institutional training.

In this exploratory sequential mixed-methods study, a focus group discussion was first conducted to identify key challenges and recommendations, which were then used to inform the development of a quantitative survey. The survey was administered using stratified random sampling based on institution type and scale. Thematic analysis was used for qualitative data, and descriptive statistics, t-tests, analysis of variance, and multiple linear regression were applied to analyze the quantitative findings.

Ten pandemic-prevention leaders participated in the focus group discussion, which revealed the four key themes of "Adapting to evolving and unfamiliar roles," "Being overwhelmed by exhaustion during the sudden pandemic," "Lack of competence in nonroutine care," and "Comprehensive and systematic approach at all levels." The quantitative survey yielded 253 valid responses. The average score for Strategies for Prevention Effectiveness was 28.1 (scale range=9-36), indicating a generally positive self-assessment. However, 6.8% of pandemic prevention supervisors (17 of the 253 participants) had not received COVID-19-related training. The analysis highlighted the importance of incorporating successful prevention experiences from other institutions and providing frontline health care workers with education on pandemic-related regulations. The average score for Educational Training was 16.2 (scale range=5-20), reflecting strong agreement with the listed training items. No significant differences were found in pandemic strategy effectiveness by either institution type (t=1.664, p=.097) or scale (F=0.571, p=.566).

The results show generally positive self-assessments of prevention strategies but revealed key challenges, including role confusion, frontline exhaustion, and training gaps. Although the World Health Organization has declared COVID-19 to no longer be a public health emergency of international concern, these issues remain critical to institutional preparedness. The findings offer transferable insights that may inform future pandemic response planning in long-term care settings, regardless of the nature of the infectious threat.