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BMC Palliative Care
Published in: BMC Palliative Care 1/2024

Open Access 01-12-2024 | COVID-19 | Research

“They choke to death in front of your very eyes”: nurses’ lived experiences and perspectives on end-of-life care during COVID-19

Author: Daniel Sperling

Published in: BMC Palliative Care | Issue 1/2024

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Abstract

Background

The COVID-19 pandemic led to an intensified fear and threat of dying, combined with dying and grieving in isolation, in turn significantly impacting nursing in end-of-life situations. The study aims (1) to understand the lived experiences of nurses who provided care to end-of-life patients during COVID-19; and (2) to explore whether providing care under such circumstances altered the perspectives of these nurses regarding end-of-life care.

Methods

Applying the phenomenological-interpretive qualitative approach, 34 in-depth semi-structured interviews were conducted between March 2020-May 2021 with nurses from eight hospitals in Israel who were recruited through purposive and snowball sampling. Thematic analysis was applied to identify major themes from the interviews.

Results

Five main themes emerged from the analysis, including: (1) a different death; (2) difficulties in caring for the body after death; (3) the need for family at end-of-life; (4) weaker enforcement of advance care directives; and (5) prolonging the dying process.

Discussion

During the pandemic, nurses encountered numerous cases of death and dying, while facing ethical and professional issues regarding end-of-life care. They were required to administer more aggressive care than usual and even necessary, leading to their increased moral distress. The nurses’ ethical concerns were also triggered by the requirement to wrap the corpse in black garbage-like bags to prevent contagion, which they felt was abusing the dead. The findings also demonstrate how family presence at end-of-life is important for the nursing staff as well as the patient. Finally, end-of-life situations during the pandemic in Israel were managed in an individual and personal manner, rather than as a collective mission, as seen in other countries.

Conclusions

The study offers insights into the nurses’ attitudes towards death, dying, and end-of-life care. An emphasis should be placed on the key elements that emerged in this study, to assist nurses in overcoming these difficulties during and after medical crises, to enhance end-of-life care and professionalism and decrease burnout.
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Literature
1.
Maben J, Conolly A, Abrams R, Rowland E, Harris R, Kelly D, et al. You can’t walk through water without getting wet’ UK nurses’ distress and psychological health needs during the Covid-19 pandemic: a longitudinal interview study. Int J Nurs Stud. 2022;131:104242.CrossRefPubMedPubMedCentral
2.
Simpson N, Angland M, Bhogal JK, Bowers RE, Cannell F, Gardner K et al. Good’ and bad’ deaths during the COVID-19 pandemic: insights from a rapid qualitative study. BMJ Glob Heal. 2021;6(6).
3.
Sudai M. Not dying alone: the need to Democratize Hospital Visitation policies during Covid-19. Med Law Rev. 2021;29(4).
4.
Nelson-Becker H, Victor C. Dying alone and lonely dying: media discourse and pandemic conditions. J Aging Stud. 2020;55.
5.
Hendriks VJJ, Faes MC, van der Meer JBL, Janse ES, van der Meer NJM, van der Linden CMJ. Shared decision-making in advance care planning among hospitalized older COVID-19 patients: a multicenter, retrospective cohort study. Aging Clin Exp Res. 2022;34(12).
6.
Younan S, Cardona M, Sahay A, Willis E, Ni Chroinin D. Advanced care planning in the early phase of COVID-19: a rapid review of the practice and policy lessons learned. Front Heal Serv. 2023;3.
7.
Hirakawa Y, Saif-Ur-Rahman KM, Aita K, Nishikawa M, Arai H, Miura H. Implementation of advance care planning amid the COVID-19 crisis: a narrative review and synthesis. Volume 21. Geriatrics and Gerontology International; 2021.
8.
Corpuz JCG. Responding to the fear of dying alone during COVID-19 pandemic. J Public Heal (United Kingdom). 2021;43(3).
9.
Rabow MW, Huang CHS, White-Hammond GE, Tucker RO. Witnesses and victims both: Healthcare Workers and grief in the time of COVID-19. J Pain Symptom Manage. 2021;62(3).
10.
Vázquez-Sánchez MÁ, Ayllón-Pérez V, Gutiérrez-Sánchez D, Valero-Cantero I, Fernandez-Ordoñez E, García-Gámez M et al. Professional grief among nurses in Spanish public health centers after caring for COVID-19 patients. J Nurs Scholarsh. 2023;55(1).
11.
Castaldo A, Lusignani M, Papini M, Eleuteri S, Matarese M. Nurses’ experiences of accompanying patients dying during the COVID-19 pandemic: a qualitative descriptive study. J Adv Nurs. 2022;78(8).
12.
Sperling D. Nurses’ challenges, concerns and unfair requirements during the COVID-19 outbreak. Nurs Ethics. 2021;28:7–8.CrossRef
13.
14.
Aydogdu ALF. Ethical dilemmas experienced by nurses while caring for patients during the COVID-19 pandemic: an integrative review of qualitative studies. J Nurs Adm Manag. 2022.
15.
Cardoso MFPT, Martins MMFP, da Trindade S, de Ribeiro L, Fonseca OMPL. EF. The COVID-19 pandemic and nurses’ attitudes toward death. Rev Lat Am Enfermagem. 2021;29.
16.
Chisbert-Alapont E, García-Salvador I, De La Ossa-Sendra MJ, García-Navarro EB, De La Rica-Escuín M. Influence of palliative care training on nurses’ attitudes towards end-of-life care during the covid-19 pandemic in Spain. Int J Environ Res Public Health. 2021;18:21.CrossRef
17.
Voultsos Polychronis TADMTAK. A Qualitative Study of Nursing Practitioners’ Experiences on Dying Alone Due to COVID-19 in Greece. 2022.
18.
Mitchinson L, Dowrick A, Buck C, Hoernke K, Martin S, Vanderslott S et al. Missing the human connection: a rapid appraisal of healthcare workers’ perceptions and experiences of providing palliative care during the COVID-19 pandemic. Palliat Med. 2021;35(5).
19.
Cohen-Mansfield J. The impact of COVID-19 on long-term care facilities and their staff in Israel: results from a mixed methods study. J Nurs Manag. 2022;30(7).
20.
Clarfield AM, Dwolatzky T, Brill S, Press Y, Glick S, Shvartzman P et al. Israel Ad Hoc COVID-19 Committee: guidelines for care of older persons during a pandemic. J Am Geriatr Soc. 2020;68(7).
21.
Jabłońska K, Aballéa S, Toumi M. The real-life impact of vaccination on COVID-19 mortality in Europe and Israel. Public Health. 2021;198.
22.
Rosen B, Waitzberg R, Israeli A. Israel’s rapid rollout of vaccinations for COVID-19. Isr J Health Policy Res. 2021;10(1).
23.
Mosheva M, Gross R, Hertz-Palmor N, Hasson-Ohayon I, Kaplan R, Cleper R et al. The association between witnessing patient death and mental health outcomes in frontline COVID-19 healthcare workers. Depress Anxiety. 2021;38(4).
24.
Sperling D. Ethical dilemmas, perceived risk, and motivation among nurses during the COVID-19 pandemic. Nurs Ethics. 2021;28(1).
25.
O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9).
26.
Smith JA. Reflecting on the development of interpretative phenomenological analysis and its contribution to qualitative research in psychology. Qual Res Psychol. 2004;1(1).
27.
28.
Campbell S, Greenwood M, Prior S, Shearer T, Walkem K, Young S et al. Purposive sampling: complex or simple? Research case examples. J Res Nurs. 2020;25(8).
29.
Smith JA, Osborn M. Interpretative Phenomenological Analysis. Doing Social Psychology Research. Wiley; 2004. pp. 229–54.
30.
31.
Tufford L, Newman P. Bracketing in qualitative research. Qual Soc Work. 2012;11(1):80–96.CrossRef
32.
Varpio L, Ajjawi R, Monrouxe LV, O’Brien BC, Rees CE. Shedding the cobra effect: problematising thematic emergence, triangulation, saturation and member checking. Med Educ. 2017;51(1):40–50.CrossRefPubMed
33.
Campbell JL, Quincy C, Osserman J, Pedersen OK. Coding In-depth semistructured interviews. Sociol Methods Res. 2013;42(3):294–320.MathSciNetCrossRef
34.
Kanaris C. Moral distress in the intensive care unit during the pandemic: the burden of dying alone. Intensive Care Med. 2021;47(1):141–3.CrossRefPubMed
35.
Patterson JE, Edwards TM, Griffith JL, Wright S. Moral distress of medical family therapists and their physician colleagues during the transition to COVID-19. J Marital Fam Ther. 2021;47(2).
36.
Mendlovic J, Haklay I, Elliott R, Lahad M. COVID-19’s impact on Medical Staff Wellbeing: investigating trauma and resilience in a longitudinal study—are doctors truly less vulnerable than nurses? Trauma Care. 2023;3(3):185–201.CrossRef
37.
Montgomery CM, Humphreys S, McCulloch C, Docherty AB, Sturdy S, Pattison N. Critical care work during COVID-19: a qualitative study of staff experiences in the UK. BMJ Open. 2021;11(5).
38.
Filc D, Davidovitch N. Rethinking the private–public mix in health care: analysis of health reforms in Israel during the last three decades. J Heal Serv Res Policy. 2016;21(4).
39.
Maron A, Shalev M. In: Maron A, Shalev M, editors. Neoliberalism as a state project: changing the political economy of Israel. Oxford University Press; 2017.
40.
Sizoo EM, Monnier AA, Bloemen M, Hertogh CMPM, Smalbrugge M. Dilemmas with restrictive visiting policies in Dutch nursing homes during the COVID-19 pandemic: a qualitative analysis of an Open-Ended Questionnaire with Elderly Care Physicians. J Am Med Dir Assoc. 2020;21(12).
41.
Rashidi KGF. FM. AF. Ethical challenges experienced by Physicians and nurses in Caring for patients with COVID-19: a qualitative study. Shiraz E-Med J. 2022.
42.
Dopelt K, Cohen D, Amar-Krispel E, Davidovitch N, Barach P. Facing death: attitudes toward physician-assisted end of life among physicians working at a tertiary-care-hospital in Israel. Int J Environ Res Public Health. 2021;18(12).
43.
Karako-Eyal N, GR. The end of life decision-making process in Israel: Bioethics, Law and the practice of doctors. In: Boas H, H-DY. DN, editors. Bioethics and Biopolitics in Israel: Socio-legal, political and empirical analysis. Cambridge University Press; 2018. pp. 240–57.
44.
Maffoni M, Argentero P, Giorgi I, Hynes J, Giardini A. Healthcare professionals’ moral distress in adult palliative care: a systematic review. BMJ Support Palliat Care. 2019;9(3):245–54.CrossRefPubMed
45.
46.
Rodney PA. What we know about moral distress. Am J Nurs. 2017;117(2).
47.
Lake ET, Narva AM, Holland S, Smith JG, Cramer E, Rosenbaum KEF et al. Hospital nurses’ moral distress and mental health during COVID-19. J Adv Nurs. 2022;78(3).
48.
Rezaee N, Mardani-Hamooleh M, Seraji M. Nurses’ perception of ethical challenges in caring for patients with covid-19: a qualitative analysis. J Med Ethics Hist Med. 2020;13.
49.
Silverman HJ, Kheirbek RE, Moscou-Jackson G, Day J. Moral distress in nurses caring for patients with Covid-19. Nurs Ethics. 2021;28(7–8):1137–64.CrossRefPubMed
50.
Schweda M, Schicktanz S, Raz A, Silvers A. Beyond cultural stereotyping: views on end-of-life decision making among religious and secular persons in the USA, Germany, and Israel. BMC Med Ethics. 2017.
51.
Statler TM, Hsu F-C, Silla L, Sheehan KN, Cowles A, Brooten JK, et al. Occurrence of Advance Care Planning and Hospital Course in patients admitted for Coronavirus Disease 2019 (COVID-19) during the pandemic. Am J Hosp Palliat Med. 2023;40(6):669–76.CrossRef
52.
Shah S, Makhnevich A, Cohen J, Zhang M, Marziliano A, Qiu M, et al. Early DNR in older adults hospitalized with SARS-CoV-2 infection during initial pandemic surge. Am J Hosp Palliat Med. 2022;39(12):1491–8.CrossRef
53.
Spacey A, Porter S. Understanding advance care planning in care homes throughout the COVID-19 pandemic: a critical realist review and synthesis. Palliat Med. 2023;37(5):663–76.CrossRefPubMed
54.
Inokuchi R, Hanari K, Shimada K, Iwagami M, Sakamoto A, Sun Y et al. Barriers to and facilitators of advance care planning implementation for medical staff after the coronavirus disease 2019 pandemic: an overview of reviews. 2023.
55.
Bradshaw A, Dunleavy L, Walshe C, Preston N, Cripps RL, Hocaoglu M, et al. Understanding and addressing challenges for advance care planning in the COVID-19 pandemic: an analysis of the UK CovPall survey data from specialist palliative care services. Palliat Med. 2021;35(7):1225–37.CrossRefPubMed
56.
Mohammed S, Peter E, Killackey T, Maciver J. The nurse as hero discourse in the COVID-19 pandemic: a poststructural discourse analysis. Int J Nurs Stud. 2021;117:103887.CrossRefPubMedPubMedCentral
57.
Werse NR, Death. Resurrection and the World to Come: Jewish Views on Death and Afterlife. In: The Routledge Handbook of Death and the Afterlife.2018.
58.
Paal P, Müller A, Gil W, Goldzweig G, Elsner F. Nurturing socioculturally and medically appropriate Palliative Care Delivery: lessons learned by Israeli Medical Faculty. J Relig Health. 2022;61(2).
59.
Oliviere D, Monroe B, Payne S. Death, Dying, and Social Differences. Death, Dying, and Social Differences. 2012.
60.
Bradshaw A, Ostler S, Goodman C, Batkovskyte I, Ellis-Smith C, Tunnard I et al. Provision of palliative and end-of-life care in UK care homes during the COVID-19 pandemic: a mixed methods observational study with implications for policy. Front Public Heal. 2023;11.
61.
Hossain F, Clatty A. Self-care strategies in response to nurses’ moral injury during COVID-19 pandemic. Nurs Ethics. 2021;28(1):23–32.CrossRefPubMed
62.
Halms T, Strasser M, Kunz M, Hasan A. How to Reduce Mental Health Burden in Health Care workers during COVID-19?–A scoping review of Guideline recommendations. Front Psychiatry. 2022;12.
63.
Moran-Ellis J, Alexander VD, Cronin A, Dickinson M, Fielding J, Sleney J et al. Triangulation and integration: processes, claims and implications. Qual Res. 2006;6(1).
64.
Snowball Sampling. In. SAGE Research Methods Foundations. 1 Oliver’s Yard, 55 City Road, London EC1Y 1SP United Kingdom. SAGE Publications Ltd; 2020.
65.
Metadata
Title
“They choke to death in front of your very eyes”: nurses’ lived experiences and perspectives on end-of-life care during COVID-19
Author
Daniel Sperling
Publication date
01-12-2024
Publisher
BioMed Central
Keyword
COVID-19
Published in
BMC Palliative Care / Issue 1/2024
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/s12904-024-01352-3

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