Perspectives across Canada about implementing a palliative approach in long-term care during COVID-19 (original) (raw)
Related papers
Journal of Personalized Medicine
Due to the interplay of multiple complex and interrelated factors, long-term care (LTC) home residents are increasingly vulnerable to sustaining poor outcomes in crisis situations such as the COVID-19 pandemic. While death is considered an unavoidable end for LTC home residents, the importance of facilitating a good death is one of the primary goals of palliative and end-of-life care. Nurse practitioners (NPs) are well-situated to optimize the palliative and end-of-life care needs of LTC home residents. This study explores the role of NPs in facilitating a dignified death for LTC home residents while also facing increased pressures related to the COVID-19 pandemic. The current exploratory qualitative study employed a phenomenological approach. A purposive sample of 14 NPs working in LTC homes was recruited. Data were generated using semi-structured interviews and examined using thematic analysis. Three categories were derived: (a) advance care planning and goals of care discussions;...
Palliative Medicine
Background: Home palliative care services have played an essential role during the first wave of the SARS-CoV-2 outbreak by providing symptom control, drug procurement, and psychological support for frail patients and their families unable to leave their homes. Aim: To understand how home palliative care professionals were affected by the outbreak, describing changes and challenges in their daily work as well as their reactions to the Covid-19 pandemic in Italy. Design: Qualitative study conducted using telephone semi-structured interviews, with thematic analysis. Setting/participants: Thirty home care professionals working for an Italian non-profit organization which provides home palliative care for cancer patients and their families. Results: Three main themes were identified. The first theme showed both patient-related and practice-related challenges participants faced in their daily work, requiring the implementation of different communication methods and patient and family edu...
Journal of Client-centered Nursing Care, 2023
Background: During the COVID-19 pandemic, care for cancer patients may be disrupted for several reasons, leading to disease progression. Home-Based palliative care, if properly managed, can provide easy and safe access to care services for these patients. This study aimed to explore stakeholders’ perceptions of home-based palliative care for cancer patients during the pandemic. Methods: This qualitative study was conducted using conventional content analysis in Tehran, Iran, in 2021. By purposeful sampling, 19 participants, including cancer patients receiving home-based care services from the Iranian Cancer Control Center (MACSA) and their families, as well as the homecare providers, were recruited. The study data were generated by conducting 19 semi-structured interviews and a focus group session and analyzed based on the method proposed by Lundman and Graneheim. Results: Qualitative analysis of the data revealed 5 main categories: “need for remote services”, “disease transmission reduction”, “management requirements”, “burnout”, and “reducing hospital workload.” Conclusion: The use of telemedicine, the existence of call centers, and the designing of appropriate guidelines, along with the help of qualified personnel, prevent the transmission of COVID-19 to cancer patients in-home palliative care and lead to the provision of comprehensive care to these patients. This approach to care helps avert staff burnout and reduces the number of occupied beds in hospitals.
Prepared to Accompany the End of Life during Pandemics in Nursing Homes
Journal of Clinical Medicine
Background: The COVID-19 pandemic confronted nursing homes with a variety of challenges to ensure the provision of palliative care for residents. PallPan-Implement aimed to adapt the recommendations of the National Strategy for the Care of Seriously Ill, Dying Adults and their Families in Times of Pandemic (PALLPAN) in such a way that nursing facilities can use and implement them. Methods: Based on 33 PALLPAN recommendations, we developed a questionnaire, conducted a pilot implementation for selected nursing homes, and asked for qualitative feedback. Results: The developed questionnaire contains 22 main questions. A three-stage pilot implementation with an introductory event, processing phase, and evaluation event took place in seven facilities. The facilities evaluated the developed questionnaire as helpful. Feedback from the facilities identified three major categories: (a) requirements for facilities should be realistic to avoid frustration, (b) the creation of a pandemic plan fo...
Geriatric Nursing, 2021
Long-term care and supportive living (LTC/SL) residents are among the most at risk for severe outcomes of COVID-19. As such, early public health measures focused on this population. This study examined the experiences and perspectives of residents and family members of residents living in LTC/SL centres in Alberta, Canada during the COVID-19 pandemic. Between July and October 2020, we conducted semi-structured interviews with 14 residents and 18 family members of residents from 10 centres. Interviews were audiorecorded and analyzed using qualitative content analysis. Analysis revealed 5 categories from resident interviews (Living with Rules and Restrictions; COVID-19 Knowledge and Information; Wellbeing; Centre Operational Response; Criticisms and Suggestions for Improvement) and 6 categories from family interviews (Family Role; Navigating the New Normal; COVID-19 Knowledge and Information; Policy Limitations; Policy Impact; Centre Response). The results highlight the importance of engaging residents and families during pandemic preparation, response, and follow-up evaluation.
Systems of Care in Crisis: The Changing Nature of Palliative Care During COVID-19
Journal of Bioethical Inquiry, 2020
Among the far-reaching impacts of COVID-19 is its impact on care systems, the social and other systems that we rely in to maintain and provide care for those with "illness." This paper will examine these impacts through a description of the influence on palliative care systems that have arisen within this pandemic. It will explore the impact on the meaning of care, how care is performed and identified, and the responses of palliative care systems to these challenges. It will also highlight the current and potential future implications of these dynamics within the unfolding crisis of this pandemic.
Journal of Hospice & Palliative Nursing, 2020
With the daily number of confirmed COVID-19 cases and associated deaths rising exponentially, social fabrics on a global scale are being worn by panic, uncertainty, fear, and other consequences of the health care crisis. Comprising more than half of the global health care workforce and the highest proportion of direct patient care time than any other health professional, nurses are at the forefront of this crisis. Throughout the evolving COVID-19 pandemic, palliative nurses will increasingly exercise their expertise in symptom management, ethics, communication, and end-of-life care, among other crucial skills. The literature addressing the palliative care response to COVID-19 has surged, and yet, there is a critical gap regarding the unique contributions of palliative nurses and their essential role in mitigating the sequelae of this crisis. Thus, the primary aim herein is to provide recommendations for palliative nurses and other health care stakeholders to ensure their optimal value is realized and to promote their well-being and resilience during COVID-19 and, by extension, in anticipation of future public health crises. KEY WORDS COVID-19, global palliative care, palliative care, palliative nursing, universal health coverage, well-being P alliative nurses play a primary and significant role in supporting the broader health care system. Right now, palliative nurses worldwide are providing an extra layer of support to nurses and care teams in emergency departments, intensive care units, skilled nursing facilities, and long-term-care environments. In the face of coronavirus disease 2019 (COVID-19), the palliative nursing
International Journal of Nursing Studies, 2021
Background: The acute nature of COVID-19 and its effects on society in terms of social distancing and quarantine regulations affect the provision of palliative care for people with dementia who live in longterm care facilities. The current COVID-19 pandemic poses a challenge to nursing staff, who are in a key position to provide high-quality palliative care for people with dementia and their families. Objective: To formulate practice recommendations for nursing staff with regard to providing palliative dementia care in times of COVID-19. Design and method: A rapid scoping review following guidelines from the Joanna Briggs Institute. Eligible papers focused on COVID-19 in combination with palliative care for older people or people with dementia and informed practical nursing recommendations for long-term care facilities. After data extraction, we formulated recommendations covering essential domains in palliative care adapted from the National Consensus Project's Clinical Practice Guidelines for Quality Palliative Care. Data sources: We searched the bibliographic databases of PubMed, CINAHL and PsycINFO for academic publications. We searched for grey literature using the search engine Google. Moreover, we included relevant letters and editorials, guidelines, web articles and policy papers published by knowledge and professional institutes or associations in dementia and palliative care. Results: In total, 23 documents (7 (special) articles in peer-reviewed journals, 6 guides, 4 letters to editors, 2 web articles (blogs), 2 reports, a correspondence paper and a position paper) were included. The highest number of papers informed recommendations under the domains 'advance care planning' and 'psychological aspects of care'. The lowest number of papers informed the domains 'ethical care', 'care of the dying', 'spiritual care' and 'bereavement care'. We found no papers that informed the 'cultural aspects of care' domain. Conclusion: Literature that focuses specifically on palliative care for people with dementia in long-term care facilities during the COVID-19 pandemic is still largely lacking. Particular challenges that need addressing involve care of the dying and the bereaved, and ethical, cultural and spiritual aspects of care. Moreover, we must acknowledge grief and moral distress among nursing staff. Nursing leadership is needed to safeguard the quality of care and nursing staff should work together within an interprofessional care team to initiate advance care planning conversations in a timely manner, to review and document advance care plans, and to adapt goals of care as they may change due to the COVID-19 situation.
BMJ Open, 2023
Objectives The objective of this study is to better understand how the COVID-19 outbreak impacted the different domains of the palliative care approach to end-oflife care from the perspective of healthcare professionals (HCPs) from different professions, working in different settings during the first months of the COVID-19 outbreak in the Netherlands. Methods An in-depth qualitative interview study among 16 HCPs of patients who died between March and July 2020 in different healthcare settings in the Netherlands. The HCPs were recruited through an online survey about end-of-life care. Maximum variation sampling was used. Data were analysed following the principles of thematic analysis. Results Several aspects impacted the quality of the palliative care approach to care at the end of life. First, COVID-19 was a new disease and this led to challenges in the physical domain of end-of-life care, for example, a lack of knowledge on how to manage symptoms and an unreliable clinical view. Second, the high workload HCPs experienced impacted the quality of end-of-life care, especially in the emotional, social and spiritual domains, since they only had time for urgent, physical care. Third, COVID-19 is a contagious disease and measures taken to prevent the spread of the virus hampered care for both patients and relatives. For example, because of the visiting restrictions, HCPs were not able to provide emotional support to relatives. Finally, the COVID-19 outbreak also had a potentially positive impact in the longer term, for example, more awareness of advance care planning and the importance of end-of-life care that includes all the domains. Conclusion The palliative care approach, which is key to good end-of-life care, was often negatively influenced by the COVID-19 pandemic, predominantly in the emotional, social and spiritual domains. This was related to a focus on essential physical care and prevention of the spread of COVID-19.
Progress in Palliative Care
Being a patient in need of specialized palliative during the COVID-19 pandemic is challenging. Governments around the world have reduced the available health care services as well as restricted inperson meetings between patients, health care professionals, and relatives. The aim of this study was to explore the experiences of patients with specialized palliative care needs during the period of restrictions requiring social distancing due to the COVID-19 pandemic. The analysis of this qualitative study was guided by a grounded theory approach. The participants were patients living in their own homes who were being treated by the outpatient clinic palliative care unit at the Herlev and Gentofte University Hospital in Denmark. Participants' main concern was maintaining control during the pandemic. They achieved this by aiming to secure a meaningful life by remaining occupied during the day, balancing social contact, contemplating the reopening of society, and seeking help from health care professionals. Participants were concerned about losing control and this concern increased with the reopening of society. Health care professionals must ensure that they provide support and care for patients with specialized palliative care needs when societal restrictions change.