{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:34:58Z","timestamp":1790188498240,"version":"4.1.0"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T00:00:00Z","timestamp":1745280000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["KL2TR002015"],"award-info":[{"award-number":["KL2TR002015"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background and Objectives<\/jats:title>\n                  <jats:p>Social activities are recognized as vital for older adults\u2019 quality of life. The COVID-19 pandemic presented challenges for nursing home (NH) staff as they attempted to balance infection risks with residents\u2019 preferences for social activities. The purpose of this study was to gain an understanding of NH staff\u2019s experiences and actions accommodating resident preferences for social activities during pandemic restrictions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research Design and Methods<\/jats:title>\n                  <jats:p>This study used a convergent mixed methods approach to provide an in-depth description of NH staff\u2019s (N\u2005=\u200524) risk propensity and decision-making. Quantitative data included self-reported demographics and risk perceptions using the Risk Propensity Scale. Qualitative data included semistructured individual interviews. Data were integrated to explain the link between individual risk perceptions and infection control practices related to social activities.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Participants were purposively sampled to reflect a range of direct care NH staff roles including certified nursing assistants (29%), activities staff (25%), social workers (25%), and licensed nurses (21%). Participants were on average 39 years of age, mostly White (79%), and female (88%). Most identified as risk-avoiders (58%). Guided content analysis of interviews revealed two main themes that describe staff\u2019s behaviors while balancing infection control and residents\u2019 social activity preferences: factors of decision-making (family influence, organizational, staff and resident characteristics) and staff influencing preference-based care (cognitive skills and technical skills).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion and Implications<\/jats:title>\n                  <jats:p>Risk perceptions and resultant decision-making vary among direct care NH staff. Mixed interpretation offers insight on staff\u2019s attempt to balance infection risks with residents\u2019 preferences to engage in social activities.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/geront\/gnaf134","type":"journal-article","created":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T05:21:58Z","timestamp":1745299318000},"source":"Crossref","is-referenced-by-count":3,"title":["Balancing Infection Risks and Residents Social Activity Preferences: Nursing Home Staff Risk Perceptions"],"prefix":"10.1093","volume":"65","author":[{"given":"Melissa","family":"McClean","sequence":"first","affiliation":[{"name":"Organizational Systems and Adult Health Department, University of Maryland School of Nursing , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nahida","family":"Akter","sequence":"additional","affiliation":[{"name":"Ross and Carol Nese College of Nursing, The Pennsylvania State University , University Park, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kal\u00e9i H","family":"Kowalchik","sequence":"additional","affiliation":[{"name":"Ross and Carol Nese College of Nursing, The Pennsylvania State University , University Park, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6082-228X","authenticated-orcid":false,"given":"Jacqueline","family":"Mogle","sequence":"additional","affiliation":[{"name":"College of Behavioral, Social and Health Sciences, Clemson University , Clemson, South Carolina ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin Ann","family":"Kitt-Lewis","sequence":"additional","affiliation":[{"name":"Ross and Carol Nese College of Nursing, The Pennsylvania State University , University Park, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anju","family":"Paudel","sequence":"additional","affiliation":[{"name":"Ross and Carol Nese College of Nursing, The Pennsylvania State University , University Park, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne Roman","family":"Jones","sequence":"additional","affiliation":[{"name":"Manning College of Nursing and Health Sciences, University of Massachusetts Boston , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8039-9466","authenticated-orcid":false,"given":"Joan G","family":"Carpenter","sequence":"additional","affiliation":[{"name":"Organizational Systems and Adult Health Department, University of Maryland School of Nursing , Baltimore, Maryland ,","place":["USA"]},{"name":"Corporal Michael J. Crescenz VAMC\u2014Philadelphia , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6143-2654","authenticated-orcid":false,"given":"Liza L","family":"Behrens","sequence":"additional","affiliation":[{"name":"Ross and Carol Nese College of Nursing, The Pennsylvania State University , University Park, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,4,22]]},"reference":[{"issue":"7","key":"2025060213312122500_CIT0001","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1001\/jama.2020.13484","article-title":"Social isolation\u2014The other COVID-19 threat in nursing homes","volume":"324","author":"Abbasi","year":"2020","journal-title":"JAMA"},{"issue":"1","key":"2025060213312122500_CIT0002","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1111\/jgs.13866","article-title":"Person-centered care: A definition and essential elements","volume":"64","author":"American Geriatrics Society Expert Panel on Person-Centered Care","year":"2016","journal-title":"Journal of the American Geriatrics Society"},{"issue":"2","key":"2025060213312122500_CIT0003","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1097\/WAD.0000000000000616","article-title":"\u201cI\u2019m not a risk taker\u201d: Risk perceptions of nursing home residents with dementia","volume":"38","author":"Behrens","year":"2024","journal-title":"Alzheimer Disease & Associated Disorders"},{"issue":"8","key":"2025060213312122500_CIT0004","doi-asserted-by":"publisher","first-page":"1424","DOI":"10.1093\/geront\/gnaa099","article-title":"Pervasive risk avoidance: Nursing staff perceptions of risk in person-centered care delivery","volume":"60","author":"Behrens","year":"2020","journal-title":"Gerontologist"},{"issue":"6","key":"2025060213312122500_CIT0005","doi-asserted-by":"publisher","first-page":"271","DOI":"10.3928\/19404921-20220930-01","article-title":"Nursing staff perceptions of outcomes related to honoring residents\u2019 \u201crisky\u201d preferences","volume":"15","author":"Behrens","year":"2022","journal-title":"Research in Gerontological Nursing"},{"issue":"2","key":"2025060213312122500_CIT0006","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3928\/00989134-20230106-02","article-title":"Assessment of nursing staff learning needs around person-centered risk management in nursing homes","volume":"49","author":"Behrens","year":"2023","journal-title":"Journal of Gerontological Nursing"},{"issue":"1","key":"2025060213312122500_CIT0007","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/geront\/gnad035","article-title":"\u201cPicturing a way forward\u201d: Strategies to manage the effects of COVID-19-related isolation on long-term care residents and their informal caregivers","volume":"64","author":"Boamah","year":"2024","journal-title":"Gerontologist"},{"issue":"1","key":"2025060213312122500_CIT0008","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.cnur.2022.10.004","article-title":"Long-term care and the COVID-19 pandemic: Lessons learned","volume":"58","author":"Boltz","year":"2023","journal-title":"The Nursing Clinics of North America"},{"issue":"1","key":"2025060213312122500_CIT0009","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1186\/s12912-021-00743-8","article-title":"How staff characteristics influence residential care facility staff\u2019s attitude toward person-centered care and informal care","volume":"20","author":"Boumans","year":"2021","journal-title":"BMC Nursing"},{"issue":"3","key":"2025060213312122500_CIT0010","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1093\/geront\/40.3.335","article-title":"The psychosocial preferences of older adults","volume":"40","author":"Carpenter","year":"2000","journal-title":"Gerontologist"},{"key":"2025060213312122500_CIT0011","author":"Centers for Disease Control and Prevention","year":"2023"},{"key":"2025060213312122500_CIT0012","volume-title":"Nursing Homes","author":"Centers for Medicare & Medicaid Services","year":"2016"},{"key":"2025060213312122500_CIT0013","volume-title":"COVID-19 Nursing Home Data","author":"Centers for Medicare & Medicaid Services","year":"2024"},{"key":"2025060213312122500_CIT0014","volume-title":"Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual","author":"Centers for Medicare & Medicaid Services","year":"2024"},{"issue":"3","key":"2025060213312122500_CIT0042","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1111\/j.1748-3743.2006.00027.x","article-title":"Risk and ageing populations: practice development research through an international research network","volume":"1","author":"Clarke","year":"2006","journal-title":"International Journal of Older People Nursing"},{"key":"2025060213312122500_CIT0015","volume-title":"Designing and conducting mixed methods research","author":"Creswell","year":"2018","edition":"third ed."},{"issue":"12","key":"2025060213312122500_CIT0016","doi-asserted-by":"publisher","first-page":"1909","DOI":"10.1016\/j.jamda.2022.10.022","article-title":"Reimagining infection control in U.S. nursing homes in the era of COVID-19","volume":"23","author":"Crnich","year":"2022","journal-title":"Journal of the American Medical Directors Association"},{"issue":"6pt2","key":"2025060213312122500_CIT0018","doi-asserted-by":"publisher","first-page":"2134","DOI":"10.1111\/1475-6773.12117","article-title":"Achieving integration in mixed methods designs\u2014Principles and practices","volume":"48","author":"Fetters","year":"2013","journal-title":"Health Services Research"},{"issue":"7187","key":"2025060213312122500_CIT0044","doi-asserted-by":"publisher","first-page":"880","DOI":"10.1136\/bmj.318.7187.880a","article-title":"Book: Dementia Reconsidered: the Person Comes First","volume":"318","author":"Flicker","year":"2011","journal-title":"BMJ"},{"issue":"7","key":"2025060213312122500_CIT0019","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1377\/hlthaff.2018.05322","article-title":"Daily nursing home staffing levels highly variable, often below CMS expectations","volume":"38","author":"Geng","year":"2019","journal-title":"Health affairs (Project Hope)"},{"key":"2025060213312122500_CIT0020","doi-asserted-by":"publisher","first-page":"Article 2022","DOI":"10.31389\/jltc.132","volume-title":"An exploration of care home staff\u2019s perceptions regarding physical activity among older adults: A qualitative systematic review (No. 2022)","author":"Hallam","year":"2022"},{"issue":"7","key":"2025060213312122500_CIT0021","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1080\/13669877.2023.2208149","article-title":"Americans\u2019 COVID-19 risk perceptions and risk perception predictors changed over time","volume":"26","author":"Johnson","year":"2023","journal-title":"Journal of Risk Research"},{"issue":"3","key":"2025060213312122500_CIT0041","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1037\/pspp0000090","article-title":"Stability and change in risk-taking propensity across the adult life span","volume":"111","author":"Josef","year":"2016","journal-title":"Journal of Personality and Social Psychology"},{"issue":"2","key":"2025060213312122500_CIT0022","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1093\/geront\/gnaa161","article-title":"#MoreThanAVisitor: Families as \u201cessential\u201d care partners during COVID-19","volume":"61","author":"Kemp","year":"2021","journal-title":"The Gerontologist"},{"key":"2025060213312122500_CIT0043","article-title":"NVivo (Version 14)","author":"Lumivero","year":"2023"},{"issue":"1","key":"2025060213312122500_CIT0024","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/jonm\/4128918","article-title":"Staff perceptions of compassionate care visits for nursing home residents during restricted visitation","volume":"2024","author":"McClean","year":"2024","journal-title":"Journal of Nursing Management"},{"key":"2025060213312122500_CIT0025","volume-title":"Theoretical basis for nursing","author":"McEwen","year":"2023","edition":"6th ed."},{"issue":"6","key":"2025060213312122500_CIT0026","doi-asserted-by":"publisher","first-page":"1506","DOI":"10.1111\/j.1559-1816.2008.00357.x","article-title":"Measuring an individual\u2019s tendency to take risks: The risk propensity scale","volume":"38","author":"Meertens","year":"2008","journal-title":"Journal of Applied Social Psychology"},{"key":"2025060213312122500_CIT0027","volume-title":"Theoretical nursing: Development and progress","author":"Meleis","year":"2018","edition":"6th ed."},{"key":"2025060213312122500_CIT0029","article-title":"The nursing home workforce","volume-title":"The national imperative to improve nursing home quality: Honoring our commitment to residents, families, and staff","author":"National Academies of Sciences, Engineering and Medicine [NASEM]","year":"2022"},{"issue":"6","key":"2025060213312122500_CIT0030","doi-asserted-by":"publisher","first-page":"3468","DOI":"10.3390\/ijerph19063468","article-title":"\u201cPrecious time together was taken away\u201d: Impact of COVID-19 restrictive measures on social needs and loneliness from the perspective of residents of nursing homes, close relatives, and volunteers","volume":"19","author":"Noten","year":"2022","journal-title":"International Journal of Environmental Research and Public Health"},{"issue":"3","key":"2025060213312122500_CIT0031","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1016\/j.gerinurse.2017.10.001","article-title":"Resident choice: A nursing home staff perspective on tensions and resolutions","volume":"39","author":"Palmer","year":"2018","journal-title":"Geriatric Nursing (New York, N.Y.)"},{"issue":"3","key":"2025060213312122500_CIT0032","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1080\/07317115.2018.1467522","article-title":"Staff-perceived conflict between resident-centered care and quality in the skilled nursing facility: Are both possible","volume":"42","author":"Parker","year":"2019","journal-title":"Clinical Gerontologist"},{"key":"2025060213312122500_CIT0033","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/j.gerinurse.2021.10.023","article-title":"Infection prevention and control in nursing homes during COVID-19: An environmental scan","volume":"43","author":"Rubano","year":"2022","journal-title":"Geriatric Nursing (New York, N.Y.)"},{"key":"2025060213312122500_CIT0034","doi-asserted-by":"publisher","first-page":"004695801877863","DOI":"10.1177\/0046958018778636","article-title":"Nursing home infection control program characteristics, CMS citations, and implementation of antibiotic stewardship policies: A national study","volume":"55","author":"Stone","year":"2018","journal-title":"INQUIRY: The Journal of Health Care Organization, Provision, and Financing"},{"issue":"10","key":"2025060213312122500_CIT0035","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1086\/501712","article-title":"The burden of infection in long-term care","volume":"21","author":"Strausbaugh","year":"2000","journal-title":"Infection Control & Hospital Epidemiology"},{"issue":"3","key":"2025060213312122500_CIT0036","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1093\/geront\/gnz075","article-title":"A preference-based model of care: An integrative theoretical model of the role of preferences in person-centered care","volume":"60","author":"Van Haitsma","year":"2020","journal-title":"Gerontologist"},{"issue":"4","key":"2025060213312122500_CIT0037","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1093\/geront\/gns102","article-title":"The preferences for everyday living inventory: Scale development and description of psychosocial preferences responses in community-dwelling elders","volume":"53","author":"Van Haitsma","year":"2013","journal-title":"Gerontologist"},{"key":"2025060213312122500_CIT0038","author":"World Health Organization","year":"2017"},{"key":"2025060213312122500_CIT0039","author":"Yang","year":"2023"}],"container-title":["The Gerontologist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/gerontologist\/advance-article-pdf\/doi\/10.1093\/geront\/gnaf134\/62966589\/gnaf134.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/gerontologist\/article-pdf\/65\/6\/gnaf134\/62966589\/gnaf134.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/gerontologist\/article-pdf\/65\/6\/gnaf134\/62966589\/gnaf134.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T17:31:32Z","timestamp":1748885492000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/gerontologist\/article\/doi\/10.1093\/geront\/gnaf134\/8117233"}},"subtitle":[],"editor":[{"given":"Joseph E","family":"Gaugler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,4,22]]},"references-count":40,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,5,10]]}},"URL":"https:\/\/doi.org\/10.1093\/geront\/gnaf134","relation":{},"ISSN":["0016-9013","1758-5341"],"issn-type":[{"value":"0016-9013","type":"print"},{"value":"1758-5341","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,6]]},"published":{"date-parts":[[2025,4,22]]},"article-number":"gnaf134"}}