Grief During the COVID-19 Pandemic: Considerations for Palliative Care Providers

Making Meaning of Integrated Care during a Pandemic: Learning from Older Adults

OBJECTIVES

The aim of the current study was to investigate meaning-making in 57 older predominantly female adults (M = 72.68) required to temporarily cease attending a university-affiliated integrated care clinic in Australia with a focus on exercise and well-being due to COVID-19 restrictions, specifically regarding consequential grief, loss, hopelessness, and loss of purpose.

METHODS

Quantitative and qualitative data were collected by telephone interviews and an online survey.

RESULTS

Results indicated that most participants valued attending the Clinic, and experienced a number of physical, social and emotional benefits from attending, including a sense of meaning. Specifically, some participants developed social connections, learned to cope more effectively with mental health conditions, and regained strength following stressful or traumatic events through their attendance at the clinic.

CONCLUSIONS

Throughout the pandemic, most participants retained their resilience and continued to derive meaning from various sources, including their families, careers, interests, and attitude toward life.

CLINICAL IMPLICATIONS

Older adults may experience enhanced physical, emotional and social health from engaging in community-based programs focused on exercise and overall wellness. Furthermore, meaning-making has the potential to buffer the harmful effects of stress and traumatic events on the physical, emotional and social health of older adults.

Relationships Between Mental Health, Emotion Regulation, and Meaning in Life of Frontline Nurses During the COVID-19 Outbreak

BACKGROUND

The sporadic outbreak of COVID-19 and the constant mutation of the virus have put the public in panic. Frontline nurses' appropriate emotional regulation and mental health are the key to win the victory of fighting against the epidemic. The relationships between these variables directly influence the availability of human resources to combat COVID-19.

OBJECTIVE

To investigate the relationship between meaning in life, emotional regulation, and mental health of frontline nurses during the Delta virus epidemic.

METHODS

A cross-sectional survey was conducted in August 2021 among 105 nurses from the Second Xiangya Hospital, Central South University, Changsha, China, who were deployed at the COVID-19 units in Zhangjiajie People's Hospital. The Chinese Meaning in Life Questionnaire, Emotion Regulation Questionnaire, and Psychological Questionnaire for Emergent Events of Public Health were used to evaluate their meaning in life, emotion regulation, and mental health. Their correlation and the moderating effect of emotion regulation were conducted.

RESULTS

In total, 105 (100%) nurses responded. There were 14 men and 91 women and the mean age was (30.295 ± 4.653) years. The average score of meaning in life and mental health of frontline nurses was 49.971 ± 6.386 and 2.755 ± 2.580, respectively. The meaning in life of frontline nurses was positively correlated with cognitive reappraisal and negatively correlated with expressive suppression and mental health. Mental health was negatively correlated with cognitive reappraisal and positively correlated with expressive suppression. The emotional regulation of frontline nurses has a moderating effect between meaning in life and mental health.

CONCLUSION

Meaning in life and emotion regulation of frontline nurses were significantly correlated with mental health under the effects of the COVID-19 pandemic. Changing the emotion regulation of frontline nurses, strengthening cognitive reappraisal, and weakening expressive suppression could reduce the predictive effect of meaning in life on mental health.

Perspectives of board-certified healthcare chaplains on challenges and adaptations in delivery of spiritual care in the COVID-19 era: Findings from an online survey

BACKGROUND

The COVID-19 pandemic has posed significant challenges for healthcare systems to meet patients' and families' complex care needs, including spiritual care needs. Little data are available about spiritual care delivery in light of the pandemic.

AIM

This study examined the impact of COVID-19 on spiritual care by healthcare chaplains in the United States.

DESIGN

An online survey of 563 board-certified chaplains was conducted from March to July 2020. The survey, designed to identify chaplains' roles in facilitating conversations about goals of care, included an open-ended question asking how COVID-19 affected chaplaincy practices; 236 chaplains responded. Quantitative data and written qualitative responses were analyzed using descriptive analysis and content analysis, respectively.

SETTING/PARTICIPANTS

Majority of participants were white (88%), female (59%), Protestant (53%), and employed full time (86%). Almost half were working in community hospitals (45%) and designated to one or more special units (48%) including ICU, palliative care, and oncology.

RESULTS

Three major themes emerged from chaplains' qualitative responses: (1) COVID-19-related risk mitigation and operational changes; (2) impact of social distancing guidelines; and (3) increased need for and provision of psychosocial and spiritual support.

CONCLUSIONS

Chaplains reported that COVID-19 challenges contributed to greater social isolation, and mental health concerns for patients, families, and healthcare staff, and substantially changed the way healthcare chaplains provided spiritual care. With evolving healthcare contexts, developing safer, more creative modes of spiritual care delivery while offering systematic support for chaplains can help meet the increasing psychosocial and spiritual needs of patients, families, and healthcare team members.

The association of mindfulness with professional quality of life and negative emotional states among critical care nurses during COVID-19 pandemic

BACKGROUND

The recent coronavirus disease 2019 (COVID-19) pandemic has imposed severe psychological pressure on nurses. Mindfulness has been shown to be effective in improving professional quality of life (ProQOL) and reducing psychological distress in a wide range of populations and contexts. However, its role in supporting critical care nurses during the outbreak of COVID-19 has yet to be established.

PURPOSE

This study explores the relationship of mindfulness with negative emotional states and ProQOL among nurses working in critical care units during COVID-19 pandemic.

METHODS

A cross-sectional descriptive correlational design was used. A sample of 156 critical care nurses completed self-reported measures of mindfulness, ProQOL, and negative emotional states. Multiple regressions were used to address the study purpose.

RESULTS

Overall, the participants had severe anxiety, moderate depression, moderate stress, moderate burnout, moderate secondary traumatic stress, and moderate compassion satisfaction. Mindfulness was significantly and negatively associated with stress (r = - 0.230, p = .004), depression (r = - 0.190, p = .018), burnout (r = - 0.218, p = .007), and secondary traumatic stress (r = - 0.168, p = .037). Mindfulness explained 3% of the variance in depression (B = -0.19, p = .018), 3.9% of variance in stress, (B = -0.201, p = .012), 4.2% of variance in BO (B = -0.206, p = .009), and 2.2% of the variance in secondary traumatic stress (B = -0.168, t = -2.104, p = .037), controlling for demographics.

CONCLUSIONS

The current study provides preliminary evidence that mindfulness can be helpful in reducing critical care nurses' psychological distress and promoting their ProQOL, and is worthy of further investigation in this population.

When 'Being There' Is Disallowed: Disruptions to Knowing and Caring During COVID-19 Visitor Restrictions

This qualitative study explored the accounts of five health professionals working in hospitals in Hamilton, Ontario, Canada who provided end-of-life care during the COVID-19 pandemic. The study goal was to understand how palliative care providers experienced and responded to the significant change in family presence when visitors were restricted to slow the spread of the virus. Identified was the loss and disruption of important forms of knowing including observational and embodied knowing. Family members' knowledge of how their person was faring was curtailed, as was providers' capacities to know families personally. Family members' less obvious needs did not come forward as readily in the absence of informal encounters with providers. Constraints on knowing and embodied actions often meant phone and video meetings failed to provide meaningful connection. Providers adapted their practice in a range of ways, including by offering verbal and visual images of the person in the setting, paying attention differently, and conveying to family members their knowledge of patients as individuals. The changes and challenges health providers remarked on and the ways they adapted and extended themselves reveal in a new way how the regular presence of family in the care setting shapes the quality of end-of-life care.

Sensory experiences of one's deceased spouse in older adults: An analysis of predisposing factors

Objectives This study focuses on pre-disposing factors associated with sensory experiences of the deceased (SED), also called bereavement hallucinations. Even though SED are common among older widowed adults, our knowledge of these experiences is still limited.Method Survey responses were obtained from 310 older widowed participants (M = 70.05 ± 8.39), complemented with data from Danish national registers.Results Hierarchical logistic regression analysis revealed four significant pre-disposing factors: prior experiences of SED in the context of previous significant bereavements (OR = 4.72), a history of interpersonal trauma (OR = 5.8), high pre-death relationship closeness (OR = 2.76) and stronger religious/spiritual worldview (OR = 1.12). No association to registered mental health diagnosis was identified.Conclusion: SED may be considered an interpersonal experience, which may be more likely to occur if the pre-death relationship is described as very close and if the bereaved has previously experienced interpersonal trauma. We argue that SED should not necessarily be considered an indication of neurodegenerative or psychiatric diseases.

Acceptability of videoconferencing to preserve the contact between cognitively impaired long-term care residents and their family caregivers: A mixed-methods study

Visiting restrictions had to be imposed to prevent the spread of the COVID-19 virus and ensure the safety of long-term care home (LTCH) residents. This mixed method study aimed to explore residents' and family caregivers' acceptability of electronic tablets used to preserve and promote contact. Semi-structured individual interviews with 13 LTCH residents and 13 family caregivers were done to study their experiences, as well as the challenges and resources encountered in the implementation and use of videoconferencing. They had to rate, on a scale from 0 to 10, each of the 6 Theoretical Framework of Acceptability' constructs of the acceptability of the intervention. The results confirm acceptability of videoconferencing, giving residents and caregivers the opportunity to talk to and see each other during the pandemic. Videoconferencing had some benefits, such as being less expensive, and taking less time and effort for family caregivers.

Lived Experiences and Challenges of the Families of COVID-19 Victims: A Qualitative Phenomenological Study in Tehran, Iran

Being COVID-19 positive and then dying causes a slew of personal, familial, and social issues for family members. Therefore, the current study was carried out to analyze the lived experiences and issues of COVID-19 victims' families in Tehran, Iran. The phenomenological approach was used in the qualitative analysis of 21 first-degree relatives of COVID-19 victims. From August 22 to October 21, 2020, data was gathered by phone (4 people) and in-person (17 people) using semi-structured interviews. The subjects were chosen through purposeful and snowball sampling. The MAXQDA-2018 program was used to organize the data, and the Colaizzi analytical technique was used to analyze it. Guba and Lincoln's criteria were also used to assess the findings' quality. After analyzing the data, 2 main categories and 14 subcategories were extracted, including (1) challenges in caring for a COVID-19 patient (being rejected, limited access to medical facilities, dissatisfaction with the behavior of medical staff, disruption of family life, the challenge of managing family members' behavior with the patient, and living with doubts and worries (2) challenges after a COVID-19 patient's death (incomplete farewell to the corpse, unbelievability of the death, ambiguity and tension in the burial process, lonely burial, the twinge of conscience, worry about not respecting the deceased, incomplete condolences, and abandonment). The troubles of victims' families can be ameliorated by developing the skills of caring for COVID-19 patients at home, providing medical and psychological services to families before and after the patient's death, appropriately informing the families to guarantee them about dignity and respect and respect of the deceased at the interment, and developing a culture of virtual condolence to provide emotional support to survivors.

Prevalence of Anxiety Symptoms and Associated Clinical and Sociodemographic Factors in Mexican Adults Seeking Psychological Support for Grief During the COVID-19 Pandemic: A Cross-Sectional Study

The COVID-19 pandemic is one of the greatest challenges in modern history, with more than four million confirmed deaths worldwide. To date, evidence regarding the psychological impact of the COVID-19 pandemic on grievers is scarce for developing countries such as Mexico. This study aimed to assess the levels of anxiety and associated concerns in a sample of Mexican adults bereaved during the COVID-19 outbreak. A cross-sectional study was conducted through the Duelo COVID (COVID Grief) platform, which is a self-guided online treatment. A total of 5,224 participants reported their anxiety, depression, sleep quality, avoidance, and arousal, prolonged grief symptoms, and medication consumption. Independent sample Mann-Whitney U-tests, chi-square tests, and Kruskal-Wallis tests, as well as multinomial logistic regression, were conducted. Results indicated that 90.4% of the participants reported clinical levels of anxiety, depression, and sleep affectations. The people who lost someone during the last 5 months scored higher in normal grief symptoms compared to the people whose loss was 6 months ago or more, and 9.8% of individuals reported the use of prescription medication, with anxiolytics and antidepressants being the most common. Females, younger respondents, unemployed people with a lower educational level, and participants who disclosed a recent suicide attempt were among those who reported medication consumption. Sleep problems were more frequent in older participants.

Rituais fúnebres na pandemia de COVID-19 e luto: possíveis reverberações

Resumo Objetivo compreender a ausência de rituais fúnebres na pandemia de COVID-19 no processo de viver o luto das famílias brasileiras que perderam entes queridos por COVID-19. Método pesquisa qualitativa documental realizada em três jornais disponibilizados online. Foram analisadas 67 reportagens, divididas em duas categorias; a primeira trata dos sofrimentos psicológicos derivados do isolamento social, como ansiedade, depressão, solidão e medo; e a segunda trata das diferentes manifestações do luto e o efeito psicológico das perdas em meio à pandemia. Resultado a ritualização da morte é indissociável do processo de elaboração das perdas. A ausência de rituais fúnebres, aliada ao distanciamento social, repercute de forma desafiadora para a sociedade e para os profissionais da saúde mental. Estratégias não presenciais de demonstração de afeto e elaboração da perda podem amenizar o isolamento imposto pela pandemia. Conclusões e implicações para a prática o processo de viver humano é repleto de ritos de passagem e a ritualística na morte-morrer se mostra necessária para a vivência da despedida, da certeza do distanciamento ocorrido entre entes e família. Implica em modos resolutivos de registro emocional, mental e mesmo físico da expressão pública de sofrimento do enlutado e do não esquecimento do Ser à morte. Impacta na prática assistencial para o acolhimento, orientação e elaboração das perdas para a manutenção de vida saudável das pessoas enlutadas, o que propõe argumentos teórico-reflexivos no cuidado em saúde mental e na guarida de pessoas enlutadas decorrentes da pandemia.

COVID-19 palliative care toolkit development and military health system deployment

BACKGROUND

During the initial phase of the pandemic, we identified a critical gap in the Military Health System's access to palliative care. Our team of nurse scientists and evidence-based practice (EBP) facilitators aimed to develop and implement an evidence-based point of care palliative care toolkit for frontline workers in inpatient settings lacking established palliative care specialists.

METHODOLOGY

We utilized Melnyk and Fineout-Overholt's (2018) seven-step EBP process. Six central themes were derived from 17 publications providing an evidence-base for toolkit resource selection and development. Our practice change implementation was piloted at a large West Coast military treatment facility. We included iPads in the toolkit for patient communication and palliative mobile application use.

RESULTS

The most significant finding was the critical and continued need for basic palliative care education and training. Integrating the palliative care toolkit into daily practice was promising yet challenging due to the high volume of deployed medical staff.

Randomized controlled trial for the efficacy of three versus five sessions of grief counseling on the psychological aspects following COVID-19 bereavement: A study protocol

BACKGROUND

During the COVID-19 pandemic, many people have experienced traumatic losses and therefore are at risk of developing complicated grief regarding the restrictions on the performance of routine mourning rituals. This study is a randomized controlled trial for assessing the efficacy of three versus five sessions of grief counseling on grief intensity, psychological distress, and quality of life of grief among bereaved people due to COVID-19.

METHODS

A total of 120 bereaved people, due to COVID-19, will be enrolled in this multi-center randomized controlled trial after assessment for inclusion and exclusion criteria. Following the informed consent procedure, participants will be allocated into two groups equally by the Stratified Balanced Block Randomization, one of them delivering a three-session grief counseling intervention and the other delivering a five-session grief counseling intervention. The intervention will be delivered by trained psychologists via in-person individual sessions. The primary outcome is grief intensity, and the secondary outcomes are psychological distress, quality of life, and satisfaction of the participants. These outcomes will be measured by the Grief Intensity Scale (GIS), the General Health Questionnaire-28 (GHQ-28), the Short Form Health Survey-12 (SF-12), and the Client Satisfaction Questionnaire (CSQ-8), respectively. The assessments will be done at three time points, one before the intervention and the others 1 month and 3 months after the intervention. The data will be analyzed using the SPSS V.18 and Stata V.11 software. The analysis approach will be "intention to treat."

DISCUSSION

Results of this study can be applied for selecting the most suitable intervention leading to the prevention of complicated grief and the maintenance and promotion of the mental health of bereaved people due to COVID-19.

CLINICAL TRIAL REGISTRATION

[irct.ir], identifier [IRCT20200505047305N1].

Death anxiety and burnout in intensive care unit specialists facing the COVID-19 outbreak: The mediating role of obsession with COVID-19 and coronaphobia

The aim of the study was to examine the role of the obsession with COVID-19 thoughts and coronaphobia in the relationship of death anxiety with burnout among staff working at infectious diseases hospitals in the front-line of the fight against COVID-19. A cross-sectional online survey (N = 110) was conducted during the second wave of the COVID-19 pandemic. Results showed that obsession with COVID-19 and coronaphobia mediated the relationship of death anxiety with burnout. Most of the participants reported higher levels of death anxiety compared with the general population and nurses reported higher levels of death anxiety than physicians.

Reconnecting: Strategies for Supporting Isolated Older Adults during COVID-19 through Tele-palliative Care

The COVID-19 pandemic has resulted in unprecedented levels of social isolation which has negatively impacted older patients in particular on multiple levels. We present a case of an older patient with several complex psychosocial issues who was hospitalized and died from COVID-19. The social isolation required during the pandemic compounded patient and family stressors and diminished the patient's access to clinicians and to his usual support network and coping strategies. We describe how technology and tele-palliative care were utilized to reconnect the patient with clinicians and family and to provide clinical care that enhanced coping skills and support. Using telemedicine to restructure the approach to care was crucial in improving multiple domains of care and can be considered a resource for caring for older adults, especially during the challenging times brought on by the COVID-19 pandemic.

Psychosocial factors associated with complicated grief in caregivers during COVID-19: Results from a preliminary cross-sectional study

The COVID-19 pandemic has changed how end-of-life ceremonies are performed, affecting grief processing and bereavement experiences. In this study, caregivers of patients who died with COVID-19 during the first wave of the pandemic were asked to complete an online survey designed to detect psychosocial factors associated with the presence of complicated grief (CG). The results show CG present in 48.4% of caregivers. The marital and cohabitant status during lockdown, the perceived sense of guilt and depression levels were significantly associated with the presence of CG, whereas attendance at the funeral and social support were found to be significant protective factors.

A Qualitative Study of the Role of Palliative Care During the COVID-19 Pandemic: Perceptions and Experiences Among Critical Care Clinicians, Hospital Leaders, and Spiritual Care Providers

Background

Palliative care offers a unique skill set in response to challenges posed by the COVID-19 pandemic, with expertise in advance care planning, symptom management, family communication, end-of-life care, and bereavement. However, few studies have explored palliative care’s role during the pandemic and changes in perceptions and utilization of the specialty among health and spiritual care providers and hospital leaders.

Objective

To explore the utilization, perceptions, and understanding of palliative care among critical care clinicians, hospital leaders, and spiritual care providers during the pandemic.

Design

We conducted a qualitative study employing semi-structured, in-depth interviews.

Setting/participants

We conducted the study at a tertiary academic medical center in Boston, Massachusetts, USA. Between August and October 2020, we interviewed 25 participants from 3 informant groups: (1) critical care physicians, (2) hospital leaders, and (3) spiritual care providers.

Results

Respondents recognized that palliative care’s role increased in importance during the pandemic. Palliative care served as a bridge between providers, patients, and families; supported provider well-being; and contributed to hospital efficiency. The pandemic reinforced participants’ positive perceptions of palliative care, increased their understanding of the scope of the specialty’s practice, and inspired physicians to engage more with palliative care. Respondents indicated the need for more palliative care providers and advocated for their role in bereavement support and future pandemic response.

Conclusion

Findings highlight evolving and increased utilization of palliative care during the pandemic, suggesting a need for greater investment in palliative care programs and for palliative care involvement in public health emergency preparedness and response.

The Grief and Bereavement Experiences of Informal Caregivers: A Scoping Review of the North American Literature

Background: Informal caregivers are a significant part of the hospice and palliative care landscape as members of the interdisciplinary care team. Despite this, little is known about the impact this responsibility has on informal caregivers’ experiences of grief and bereavement. Objective: To address this, a scoping review of the literature was conducted to explore the current state of knowledge toward grief and bereavement of informal caregivers of adult/geriatric patients in the hospice and palliative/end-of-life care realm within North America. Methods: Using Arksey and O’Malley's 5-step framework, key electronic health care and social sciences databases (eg, CINAHL, MEDLINE, ProQuest Sociological Abstracts, PsycINFO) alongside gray literature sources were searched and screened against inclusion and exclusion criteria. A thematic content analysis was used to identify key themes. Results: 29 articles met the final inclusion criteria with 3 central themes emerging: (1) mediators of grief, (2) grief experiences, and (3) types of grief. Discussion: Informal caregivers encounter unique grief and bereavement experiences: The range of psychosocial outcomes, both negative and positive, can be affected by various mediators such as caregiver burden, demographics, disease type of the patient being cared for, etc. Bereavement interventions must be designed with the mediators of grief in mind. Conclusions: Understanding the nuances of informal caregivers’ experiences with grief and bereavement will inform and advance practice, policy, and research. Practitioners/clinicians should be further educated on how to properly acknowledge the complexity of grief and bereavement for informal caregivers, specifically paying attention to mediators. Further research needs to consider the role of culture.

Palliative Care Practice During the COVID-19 Pandemic: A Descriptive Qualitative Study of Palliative Care Clinicians

CONTEXT

COVID-19 created unprecedented demand for palliative care at a time when in-person communication was highly restricted, straining efforts to care for patients and families.

OBJECTIVES

To qualitatively explore the challenges presented by the COVID-19 pandemic from the perspective of palliative care clinicians. Specifically we sought to: 1) Describe the strategies adopted by palliative care clinicians to cope with new challenges including patient and clinician isolation, prognostication of an emergent disease, and rapidly rising numbers of severely ill patients; 2) Identify additions or adjustments to in-person and system-related palliative care training, methods, and tools made during pandemics.

METHODS

This descriptive qualitative study utilized a thematic approach for data analysis of individual, semi-structured interviews with palliative care clinicians (n = 25). Codes, categories, and emerging themes were identified through an iterative, comparative method. Methods align with the Consolidated Criteria for Reporting Qualitative Research (COREQ) RESULTS: A theme of "Expanding the reach of palliative care for today and the future" was identified with three subthemes: 1) Redefining attitudes and hardship due to collective uncertainty, 2) Breaking with the past towards integrated concept of palliative care, and 3) Building capacity through primary palliative care training.

CONCLUSION

COVID-19 forced hospital systems to consider the inclusion of palliative care in unforeseen ways due to an uncontrollable, unpredictable disease. Faced with unprecedented uncertainty, palliative care clinicians utilized strategies for integration and innovation across hospitals, particularly in intensive care units and emergency departments. A need to build capacity through increased primary palliative care access and training was identified.

Experiences of Hospice and Palliative Nurses in Response to the COVID-19 Pandemic: A Qualitative Study

Purpose

This study aimed to explore the experiences of hospice and palliative care (HPC) nurses at inpatient hospice centers in South Korea during the coronavirus disease 2019 pandemic.

Methods

Data collection was conducted through individual interviews with 15 HPC nurses using face-to-face interviews, telephone calls, or Zoom videoconferencing. Data were analyzed using the thematic analysis method.

Results

This study found that HPC nurses experienced practical and ethical dilemmas that reinforced the essential meaning and value of hospice and palliative care. The participants emphasized their practical roles related to compliance with infection prevention measures and their roles as rebuilders of hospice and palliative care.

Conclusion

The findings of this study indicate that inpatient hospice centers must mitigate the practical and ethical dilemmas experienced by nurses, consider establishing explanation nursing units, and provide education to support nurses' highlighted roles during the pandemic. This study can be used to prepare inpatient hospice centers and the nurses that work there for future infectious disease outbreaks.

Palliative care in COVID-19

PURPOSE OF REVIEW

The purpose of this paper is (1) to provide insight in the palliative care needs of patients with COVID-19; (2) to highlight the challenges of COVID-19 for palliative care; and (3) to highlight developments in COVID-19 palliative care.

RECENT FINDINGS

Patients with serious COVID-19 have palliative care needs in all domains: physical, psychological, social and spiritual. COVID-19 palliative care is confronted with many challenges, including: the uncertain prognosis, resource limitations, challenges regarding advance care planning, lack of guidance, limited multidisciplinary collaboration, need for remote communication, restrictions in family visits, and burden for clinicians. Palliative care responded with many developments: development of services; integration of palliative care with other services; tools to support advance care planning, (remote) communication with patients and families, or spiritual care; and care for team members.

SUMMARY

Palliative care has an important role in this pandemic. Palliative care rapidly developed services and opportunities were found to support patients, families and clinicians. Further developments are warranted to face future demands of a pandemic, including integrated palliative care and education in palliative care skills across all specialties. Intervention studies are needed to enable evidence-based recommendations for palliative care in COVID-19.

Moral distress amid COVID-19: A frontline emergency nurse's perspective

ABSTRACT

ED nurses are at high risk for developing moral distress during the COVID-19 pandemic. Predisposing factors include limited resources, inadequate staffing, PPE shortages, and caring for vulnerable populations. This article explores personal and organizational strategies to help nurses cope with moral distress.

Addressing Acute Stress among Professionals Caring for COVID-19 Patients: Lessons Learned during the First Outbreak in Spain (March-April 2020)

Objectives: To describe lessons learned during the first COVID-19 outbreak in developing urgent interventions to strengthen healthcare workers' capacity to cope with acute stress caused by health care pressure, concern about becoming infected, despair of witnessing patients' suffering, and critical decision-making requirements of the SARS-CoV-2 pandemic during the first outbreak in Spain. Methods: A task force integrated by healthcare professionals and academics was activated following the first observations of acute stress reactions starting to compromise the professionals' capacity for caring COVID-19 patients. Literature review and qualitative approach (consensus techniques) were applied. The target population included health professionals in primary care, hospitals, emergencies, and nursing homes. Interventions designed for addressing acute stress were agreed and disseminated. Findings: There are similarities in stressors to previous outbreaks, and the solutions devised then may work now. A set of issues, interventions to cope with, and their levels of evidence were defined. Issues and interventions were classified as: adequate communication initiative to strengthen work morale (avoiding information blackouts, uniformity of criteria, access to updated information, mentoring new professionals); resilience and recovery from physical and mental fatigue (briefings, protecting the family, regulated recovery time during the day, psychological first aid, humanizing care); reinforce leadership of intermediate commands (informative leadership, transparency, realism, and positive messages, the current state of emergency has not allowed for an empirical analysis of the effectiveness of proposed interventions. Sharing information to gauge expectations, listening to what professionals need, feeling protected from threats, organizational flexibility, encouraging teamwork, and leadership that promotes psychological safety have led to more positive responses. Attention to the needs of individuals must be combined with caring for the teams responsible for patient care. Conclusions: Although the COVID-19 pandemic has a more devastating effect than other recent outbreaks, there are common stressors and lessons learned in all of them that we must draw on to increase our capacity to respond to future healthcare crises.

Impact of the COVID-19 Pandemic on Palliative Care in Cancer Patients in Spain

BACKGROUND

The COVID-19 pandemic outbreak has severely affected healthcare organizations worldwide, and the provision of palliative care (PC) to cancer patients has been no exception. The aim of this paper was to analyse the levels of health care provided by the Clinical Management Unit for PC in Córdoba (Spain) for cancer patients.

METHOD

a retrospective cohort study was conducted. It analyzed the PC internal management database including all cancer patients treated in the period of 2018-2021.

RESULTS

1967 cases were studied. There was a drop in cancer cases (p = 0.008), deaths at the PC hospital (p < 0.001), and referrals from primary care (p < 0.001). However, there was a rise in highly complex clinical situations (p = 0.020) and in ECOG performance status scores of 3-4 (p < 0.001). The pandemic was not shown to be a risk factor for survival in the PC program (0.99 [0.82-1.20]; p = 0.931). However, being female (p = 0.005), being older and having a high Karnofsky Performance Status (KPS) score (p < 0.001) could be indicators of a longer stay.

CONCLUSION

The COVID-19 pandemic has presented a challenge in the management of patients requiring PC and has highlighted the urgent needs of the healthcare system if it is to continue providing a level of care which meets the needs of patients and their families.

Visitor Restrictions, Palliative Care, and Epistemic Agency: A Qualitative Study of Nurses' Relational Practice During the Coronavirus Pandemic

Efforts to curb spread of COVID-19 has led to restrictive visitor policies in healthcare, which disrupt social connection between patients and their families at end of life. We interviewed 17 Canadian nurses providing palliative care, to solicit their descriptions of, and responses to, ethical issues experienced as a result of COVID-19 related circumstances. Our analysis was inductive and scaffolded on notions of nurses' moral agency, palliative care values, and our clinical practice in end-of-life care. Our findings reveal that while participants appreciated the need for pandemic measures, they found blanket policies separating patients and families to be antithetical to their philosophy of palliative care. In navigating this tension, nurses drew on the foundational values of their practice, engaging in ethical reasoning and action to integrate safety and humanity into their work. These findings underscore the epistemic agency of nurses and highlight the limits of a purely biomedical logic for guiding the nursing ethics of the pandemic response.

Implementation of a Palliative Hospital-Centered Spiritual and Psychological Telehealth System During COVID-19 Pandemic

BACKGROUND

The severity of the COVID-19 pandemic has resulted in limited provision of palliative care and hospital teams have had to rise to the challenge of how to deliver care safely to people with palliative needs. Telehealth interventions have been seen as a useful resource with potential to improve clinical effectiveness.

OBJECTIVE

To describe the implementation of a spiritual and psychological palliative telehealth system during the pandemic.

METHODS

Pilot study based on the implementation of a telehealth system designed to support hospitalized patients referred to a mobile palliative care team, through synchronic videoconferences, and including patients' relatives. The implementation included protocol development, physical infrastructure, and training. The intervention consisted of spiritual and psychological telehealth sessions performed remotely by the chaplain and psychologist of a palliative care team.

RESULTS

During the study period 59 patients were recruited, median age of 70 years, 57.6% females. The primary diagnosis was severe COVID-19 (50.8%), advanced cancer (32.2%) and advanced chronic illness (16.9%). A total of 211 telehealth sessions were carried out, 82% psychological and 18% spiritual. The main criteria for psychological sessions were being related to seriously ill patients with withdrawal or withholding of life-support treatment (60.1%). The main criteria for spiritual sessions were being a patient with spiritual suffering or requesting spiritual assistance (73.6%). An electronic user satisfaction survey indicated high satisfaction rates.

CONCLUSION

This report demonstrates that it is possible to provide spiritual and psychological palliative care to hospitalized patients and families during pandemic restrictions through interdisciplinary telehealth delivery.

American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.

Expressing grief through metaphors: family caregivers' experience of care and grief during the Covid-19 pandemic

Purpose: The COVID-19 pandemic has disrupted thousands of individuals’ experience of caregiving and grief. This qualitative study aimed to gain in-dept understanding of family caregivers’ lived experiences of caregiving and bereavement in the context of the COVID-19 pandemic in Quebec, Canada. The study also aimed at providing new insight about caregiving and bereavement by analysing the metaphors family caregivers use to report their experiences. Methods: The design of this study was guided by an interpretative phenomenological approach. In-depth interviews were conducted with twenty bereaved family caregivers who had lost a loved one during the first waves of the pandemic. Results: Results indicate that bereaved family caregivers lived and understood their experience in terms of metaphoric cut-offs, obstructions and shockwaves. These three metaphors represented the grief process and the bereaved’s quest for social connection, narrative coherence and recognition. Conclusion: By identifying the meaning of the bereaved’s metaphors and the quest they reveal, our study underlines the singularity of pandemic grief and points to the value and meaning of caregiving with regard to the grieving process.

Moral Injury and Moral Resilience in Health Care Workers during COVID-19 Pandemic

Background: The 2019 coronavirus (COVID-19) pandemic placed unprecedented strains on the U.S. health care system, putting health care workers (HCWs) at increased risk for experiencing moral injury (MI). Moral resilience (MR), the ability to preserve or restore integrity, has been proposed as a resource to mitigate the detrimental effects of MI among HCWs. Objectives: The objectives of this study were to investigate the prevalence of MI among HCWs, to identify the relationship among factors that predict MI, and to determine whether MR can act as buffer against it. Design: Web-based exploratory survey. Setting/Subjects: HCWs from a research network in the U.S. mid-Atlantic region. Measurements: Survey items included: our outcome, Moral Injury Symptoms Scale-Health Professional (MISS-HP), and predictors including demographics, items derived from the Rushton Moral Resilience Scale (RMRS), and ethical concerns index (ECI). Results: Sixty-five percent of 595 respondents provided COVID-19 care. The overall prevalence of clinically significant MI in HCWs was 32.4%; nurses reporting the highest occurrence. Higher scores on each of the ECI items were significantly positively associated with higher MI symptoms (p < 0.05). MI among HCWs was significantly related to the following: MR score, ECI score, religious affiliation, and having ≥20 years in their profession. MR was a moderator of the effect of years of experience on MI. Conclusions: HCWs are experiencing MI during the pandemic. MR offers a promising individual resource to buffer the detrimental impact of MI. Further research is needed to understand how to cultivate MR, reduce ECI, and understand other systems level factors to prevent MI symptoms in U.S. HCWs.

Psychological Impact of the COVID-19 Pandemic and Social Determinants on the Portuguese Population: Protocol for a Web-Based Cross-sectional Study

BACKGROUND

The COVID-19 outbreak and consequent physical distance measures implemented worldwide have caused significant stress, anxiety, and mental health implications among the general population. Unemployment, working from home, and day-to-day changes may lead to a greater risk of poor mental health outcomes.

OBJECTIVE

This paper describes the protocol for a web-based cross-sectional study that aims to address the impact of the COVID-19 pandemic on mental health.

METHODS

Individuals from the general population aged 18 years or more and living in Portugal were included in this study. Data collection took place between November 10, 2020, and February 10, 2021. An exponential, nondiscriminative, snowball sampling method was applied to recruit participants. A web-based survey was developed and shared on social media platforms (eg, Facebook, Instagram, Twitter, LinkedIn, and WhatsApp groups) and through e-mail lists for recruitment of the seeds.

RESULTS

Data analysis will be performed in accordance with the different variables and outcomes of interest by using quantitative methods, qualitative methods, or mixed methods, as applicable. A total of 929 individuals had completed the web-based survey during the 3-month period; thus, our final sample comprised 929 participants. Results of the survey will be disseminated in national and international scientific journals in 2021-2022.

CONCLUSIONS

We believe that the findings of this study will have broad implications for understanding the psychological impact of the COVID-19 pandemic on Portuguese residents, as well as aspects related to the informal economy. We also hope that the findings of this study are able to provide insights and guidelines for the Portuguese government to implement action. Finally, we expect this protocol to provide a roadmap for other countries and researchers that would like to implement a similar questionnaire considering the related conclusions.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/28071.

Lived experiences of nurses providing altruistic care to patients with COVID-19

Background

The difficulty of providing care to patients with COVID-19 and the extensive social changes caused by COVID-19 have made the experience of providing care to these patients unique. The present study was conducted to explore the lived experiences of nurses providing altruistic care to patients with COVID-19.

Methods

The present qualitative phenomenological study was conducted in spring 2020 on 12 nurses (8 women and 4 men) selected by purposive sampling from hospitals admitting patients with COVID-19 in Tehran, Iran. Data were collected through open, in-depth, semi-structured interviews and were analyzed using the Glaizer technique.

Findings

The lived experiences of nurses dealing with COVID-19 included: Disquietude, with subcategories including shock and the dilemma of staying or leaving; Intellectuality, with subcategories including patience, self-sacrifice, spiritual growth; Human transcendence, with subcategories including love of the profession, community's appreciation, and improving the value of nursing.

Discussion

Nurses' experience of providing patient care has a transcendental nature, such that nurses went from the usual fears to transcendence in internal and social aspects. The experience of passing through these stages took place over a short period of time, and nurses felt good about this achievement. Despite the difficult circumstances, patient care was not unpleasant for them; rather, it made them feel like a superhuman.

Family support on intensive care units during the COVID-19 pandemic: a qualitative evaluation study into experiences of relatives

Background

During the first peak of the COVID-19 pandemic in the Netherlands, relatives of patients with COVID-19 admitted to Intensive Care Units (ICUs) were severely restricted in visiting their relatives and in communicating with treating physicians. Family communication is a core element of critical care, however, this pandemic forced medical ICU staff to arrange alternative family support for instance by Family Support Teams (FSTs), consisting of non-ICU affiliated staff who telephonically contacted relatives. This study aims to examine relatives’ experiences with FSTs on two ICUs of a Dutch university medical centre, and to evaluate its working strategies. .

Methods

In a semi-structured interview study, relatives of patients with COVID-19 admitted to ICU’s, who had been supported by the FSTs, were sampled purposively. Twenty-one interviews were conducted telephonically by three researchers. All interviews were topic list guided and audio-recorded. Data was analysed thematically.

Results

All participants indicated they went through a rough time. Almost all evaluated the FSTs positively. Four major themes were identified. First, three important pillars of the FSTs were providing relatives with transparency about the patients’ situation, providing attention to relatives’ well-being, and providing predictability and certainty by calling on a daily basis in a period characterised by insecurity. Second, relatives appeared to fulfil their information needs by calls of the FSTs, but also by calling the attending ICU nurse. Information provided by the FSTs was associated with details and reliability, information provided by nurses was associated with the patient’s daily care. Third, being a primary family contact was generally experienced as both valuable and as an emotional burden. Last, participants missed proper aftercare. Family support often stopped directly after the patient died or had left the ICU. Relatives expressed a need for extended support after that moment since they had strong emotions after discharge or death of the patient.

Conclusions

Family support in times of the extreme COVID-19 situation is important, as relatives are restricted in communication and have a strong need for information and support. Relatives feel encouraged by structure, frequency, support and understanding by FSTs. However, remote family support should be tailored to the needs of relatives. A fixed contact person on de ICU and video calling might be good extra options for family support, also in future post COVID-19 care, but cannot replace physical visits.

China Public Psychology Analysis About COVID-19 Under Considering Sina Weibo Data

COVID-19 not only poses a huge threat to public health, but also affects people’s mental health. Take scientific and effective psychological crisis intervention to prevent large-scale negative emotional contagion is an important task for epidemic prevention and control. This paper established a sentiment classification model to make sentiment annotation (positive and negative) about the 105,536 epidemic comments in 86 days on the official Weibo of People’s Daily, the test results showed that the accuracy of the model reached 88%, and the AUC value was greater than 0.9. Based on the marked data set, we explored the potential law between the changes in Internet public opinion and epidemic situation in China. First of all, we found that most of the Weibo users showed positive emotions, and the negative emotions were mainly caused by the fear and concern about the epidemic itself and the doubts about the work of the government. Secondly, there is a strong correlation between the changes of epidemic situation and people’s emotion. Also, we divided the epidemic into three period. The proportion of people’s negative emotions showed a similar trend with the number of newly confirmed cases in the growth and decay period, and the extinction period. In addition, we also found that women have more positive emotional performance than men, and the high-impact groups is also more positive than the low-impact groups. We hope that these conclusions can help China and other countries experiencing severe epidemics to guide publics respond.

"Saying goodbye all alone with no close support was difficult"- Dying during the COVID-19 pandemic: an online survey among bereaved relatives about end-of-life care for patients with or without SARS-CoV2 infection

BACKGROUND

During the SARS-CoV2 pandemic, protection measures, as well as visiting restrictions, had a severe impact on seriously ill and dying patients and their relatives. The study aims to describe the experiences of bereaved relatives of patients who died during the SARS-CoV2 pandemic, regardless of whether patients were infected with SARS-CoV2 or not. As part of this, experiences related to patients' end-of-life care, saying goodbye, visiting restrictions and communication with the healthcare team were assessed.

METHODS

An open observational post-bereavement online survey with free text options was conducted with 81 bereaved relatives from people who died during the pandemic in Germany, with and without SARS-CoV2 diagnosis.

RESULTS

67/81 of the bereaved relatives were female, with a mean age of 57.2 years. 50/81 decedents were women, with a mean age of 82.4 years. The main underlying diseases causing death were cardiovascular diseases or cancer. Only 7/81 of the patients were infected with SARS-CoV2. 58/81 of the relatives felt burdened by the visiting restrictions and 60/81 suffered from pandemic-related stress. 10 of the patients died alone due to visiting restrictions. The burden for relatives in the hospital setting was higher compared to relatives of patients who died at home. 45/81 and 44/81 relatives respectively reported that physicians and nurses had time to discuss the patient's condition. Nevertheless, relatives reported a lack of proactive communication from the healthcare professionals.

CONCLUSIONS

Visits of relatives play a major role in the care of the dying and have an impact on the bereavement of relatives. Visits must be facilitated, allowing physical contact. Additionally, virtual contact with the patients and open, empathetic communication on the part of healthcare professionals is needed.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS00023552).

Patient Portals to Support Palliative and End-of-Life Care: Scoping Review

BACKGROUND

Although patient portals are widely used for health promotion, little is known about the use of palliative care and end-of-life (PCEOL) portal tools available for patients and caregivers.

OBJECTIVE

This study aims to identify and assess the user perspectives of PCEOL portal tools available to patients and caregivers described and evaluated in the literature.

METHODS

We performed a scoping review of the academic literature directed by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) extension for Scoping Review and searched three databases. Sources were included if they reported the development or testing of a feature, resource, tool, or intervention; focused on at least one PCEOL domain defined by the National Coalition for Hospice and Palliative Care; targeted adults with serious illness or caregivers; and were offered via a patient portal tethered to an electronic medical record. We independently screened the titles and abstracts (n=796) for eligibility. Full-text (84/796, 10.6%) sources were reviewed. We abstracted descriptions of the portal tool name, content, targeted population, and reported user acceptability for each tool from included sources (n=19).

RESULTS

In total, 19 articles describing 12 tools were included, addressing the following PCEOL domains: ethical or legal (n=5), physical (n=5), and psychological or psychiatric (n=2). No tools for bereavement or hospice care were identified. Studies have reported high acceptability of tools among users; however, few sources commented on usability among older adults.

CONCLUSIONS

PCEOL patient portal tools are understudied. As medical care increasingly moves toward virtual platforms, future research should investigate the usability and acceptability of PCEOL patient portal resources and evaluate their impact on health outcomes.

Health Professionals' Perceptions of the Contributions of Palliative Care Consultation for Patients with COVID-19

Background: Palliative care (PC) programs worldwide are involved in caring for patients with coronavirus disease 2019 (COVID-19) with other professionals. Objectives: To determine health professionals' perceptions of the contributions of PC in COVID-19 care, and describe its effect on professionals' psychological distress. Design: Cross-sectional study. Setting/Subjects: Physicians, advance practice providers, nurses, and case managers at two hospitals. Measurements: Seventeen-item questionnaire on demographics, contributions of PC, and psychological distress. Results: Of 427 health professionals invited to participate, 76 responded (18%). Among 64 eligible respondents, 72% were female, 56% were under the age 40, 40.6% were nurses, 28.1% were physicians, and 66% worked in the intensive care unit. The PC team was perceived as helpful in managing pain and other symptoms, coordinating care among providers, discussing end-of-life preferences, communicating with patients and families and supporting the care team. Median self-reported psychological distress was 7 (range 2-10). Twenty-five (39%) participants agreed that PC eased distress by communicating with patients, families, and other professionals, providing guidance in difficult conversations and offering companionship. Among respondents, 84% would likely work with PC in the future. Conclusions: During the COVID-19 pandemic, health professionals perceived PC as helpful in caring for patients and families, and in easing their own psychological distress.

Improving End-of-Life Care for People with Dementia in LTC Homes During the COVID-19 Pandemic and Beyond

COVID-19 pandemic has resulted in a significant increase in deaths in long-term care homes (LTCH). People with dementia living in LTCHs represent one of the most frail and marginalized populations in Canada. The surge of COVID-19 cases in LTCHs and rationing of health-care resources during the pandemic have amplified the pre-existing need for improvements in palliative and end-of-life care in LTCHs. This position statement, created by a task force commissioned by the Alzheimer Society of Canada, provides recommendations for a multipronged coordinated approach to improving palliative and end-of-life care of people with dementia living in LTCHs during the COVID-19 pandemic and beyond.

Bereaved relatives' quality of life before and during the COVID-19 pandemic: Results of the prospective, multicenter, observational eQuiPe study

BACKGROUND

The death of a loved one is considered as one of the most stressful life events. During the COVID-19 pandemic, grief processes are potentially affected by measures such as social distancing and self-quarantine.

AIM

The aim of this study was to give insight in the impact of the COVID-19 pandemic on quality of life, social support, and self-care of bereaved relatives of people with advanced cancer in order to evaluate whether care for bereaved relatives during the COVID-19 pandemic should be improved.

DESIGN

A cross-sectional analysis using data from bereaved relatives of a prospective, longitudinal, multicenter, observational study on quality of care and quality of life of people with advanced cancer and their (bereaved) relatives (eQuiPe).

SETTING/PARTICIPANTS

Quality of life, social support, and self-care of bereaved relatives who completed a questionnaire within 3-6 months after their relative died during COVID-19 (April-November 2020) were compared with bereaved relatives who completed this questionnaire pre-COVID-19 (April-November 2019).

RESULTS

Ninety-one bereaved relatives were included in the analysis, 44 bereaved relatives completed the questionnaire pre-COVID-19 and 47 during COVID-19. The median age of the participants was 65 (IQR = 14) years and 58% were female. There were no significant differences between the pre-COVID-19 and during COVID-19 bereaved relatives in quality of life (68 vs 69), social support (17 vs 18), and self-care (20 vs 19).

CONCLUSIONS

On the short-term, the COVID-19 pandemic did not have significant impact on bereaved relatives' wellbeing. However, long-term impact of the pandemic on their wellbeing should be assessed.

Witnesses and Victims Both: Healthcare Workers and Grief in the Time of COVID-19

Heathcare Workers (HCWs) recognize their responsibility to support the bereaved loved ones of our patients, but we also must attend to our own professional and personal grief in the COVID-19 pandemic. COVID-19 grief is occurring in the setting of incomplete grief, disenfranchised grief, fractured US governmental leadership, and evidence of great mistrust, systemic racism, and social injustice. In the intensity and pervasiveness of COVID-19, HCW fears for themselves, their colleagues, and their own loved ones are often in conflict with professional commitments. Even at the dawn of promising national and global vaccination programs, significant HCW morbidity and mortality in COVID-19 has already become clear, will continue to grow, and these effects likely will last far into the future. Given the risks of complicated grief for HCWs in the setting of COVID-19 deaths, individual HCWs must put every effort into their own preparation for these deaths as well as into their own healthy grieving. Equally importantly, our healthcare systems have a primary responsibility both to prepare HCWs and to support them in their anticipatory and realized grief. Special attention must be paid to our HCW trainees, who may have not yet developed personal or professional grief management strategies and are coming into healthcare practice during a time of great disruption to both teaching and clinical care.

Existential Suffering in Palliative Care: An Existential Positive Psychology Perspective

The COVID-19 pandemic has exposed the inadequacies of the current healthcare system and needs a paradigm change to one that is holistic and community based, illustrated by the healing wheel. The present paper proposes that existential positive psychology (PP 2.0) represents a promising approach to meet the rising needs in palliative care. This framework has a twofold emphasis on (a) how to transcend and transform suffering as the foundation for wellbeing and (b) how to cultivate our spiritual and existential capabilities to achieve personal growth and flourishing. We propose that these objectives can be achieved simultaneously through dialectical palliative counselling, as illustrated by Wong's integrative meaning therapy and the Conceptual Model of CALM Therapy in palliative care. We then outline the treatment objectives and the intervention strategies of IMT in providing palliative counselling for palliative care and hospice patients. Based on our review of recent literature, as well as our own research and practice, we discover that existential suffering in general and at the last stage of life in particular is indeed the foundation for healing and wellbeing as hypothesized by PP 2.0. We can also conclude that best palliative care is holistic-in addition to cultivating the inner spiritual resources of patients, it needs to be supported by the family, staff, and community, as symbolized by the healing wheel.

Global Experiences of Pediatric Palliative Care Teams During the First 6 Months of the SARS-CoV-2 Pandemic

CONTEXT

The coronavirus pandemic (COVID-19) has profoundly impacted the provision of pediatric palliative care (PPC) interventions including goals of care discussions, symptom management, and end-of-life care.

OBJECTIVE

Gaining understanding of the professional and personal experiences of PPC providers on a global scale during COVID-19 is essential to improve clinical practices in an ongoing pandemic.

METHODS

The Palliative Assessment of Needed DEvelopments & Modifications In the Era of Coronavirus Survey-Global survey was designed and distributed to assess changes in PPC practices resulting from COVID-19. Quantitative and qualitative data were captured through the survey.

RESULTS

One hundred and fifty-six providers were included in the final analysis with 59 countries and six continents represented (31% from lower- or lower middle-income countries). Nearly half of PPC providers (40%) reported programmatic economic insecurity or employment loss. Use of technology influenced communication processes for nearly all participants (91%), yet most PPC providers (72%) reported receiving no formal training in use of technological interfaces. Respondents described distress around challenges in provision of comfort at the end of life and witnessing patients' pain, fear, and isolation.

CONCLUSIONS

PPC clinicians from around the world experienced challenges related to COVID-19. Technology was perceived as both helpful and a hinderance to high quality communication. The pandemic's financial impact translated into concerns about programmatic sustainability and job insecurity. Opportunities exist to apply these important experiential lessons learned to improve and sustain care for future patients, families, and interdisciplinary teams.

ARTICLE SUMMARY

This original article describes the impact of the COVID-19 pandemic on pediatric palliative care clinicians from 59 countries including financial losses, use of virtual communication modalities, and the respondents' distress in provision of comfort at the end of life.

Perspectivas de brasileiros durante a pandemia da Covid-19: uma análise sobre autocuidado e bioética ambiental

RESUMO Em situações de crise, como em surtos epidêmicos, o autocuidado pode ser comprometido por conflitos relacionados às vivências cotidianas. Objetivou-se caracterizar as perspectivas sobre vivências da população brasileira frente à pandemia da Covid-19, por meio do seu posicionamento frente a um questionário on-line, em uma pesquisa transversal de estratégia mista. A análise das 525 participações, ocorridas em junho de 2020, identificou vivências registradas no auge da pandemia no Brasil, em três vetores: o envolvimento emocional com causas, consequências e condutas relacionadas à Covid-19; as implicações negativas e positivas do distanciamento social; e os impactos individuais e coletivos desta medida. A pandemia da Covid-19 foi associada às consequências e aos sentimentos reflexos de tal distanciamento, com dissonância de sentimentos negativos e positivos. Embora os participantes não tenham elencado questões sobre o ambiente e o autocuidado, eles se posicionaram ao serem direcionados a refletir sobre essas questões, sendo possível identificar a transposição de percepções negativas da quarentena, associadas aos contextos individual e físico, para percepções positivas, relacionados aos aspectos emocional e coletivo. A análise das perspectivas dos respondentes deve compor a pauta da agenda da bioética ambiental, uma vez que decisões pessoais e cotidianas sobre como promover o autocuidado os inserem em uma cadeia de responsabilidades e interdependências globais.

From virtual to real healing: a critical overview of the therapeutic use of virtual reality to cope with mourning

In recent years, virtual reality (VR) has been effectively employed in several settings, ranging from health care needs to leisure and gaming activities. A new application of virtual stimuli appeared in social media: in the documentary ‘I met you’ from the South-Korean Munhwa Broadcasting, a mother made the experience of interacting with the avatar of the seven-year-old daughter, who died four years before. We think that this new application of virtual stimuli should open a debate on its possible implications: it represents contents related to grief, a dramatic and yet natural experience, that can have deep psychological impacts on fragile subjects put in virtual environments. In the present work, possible side-effects, as well as hypothetical therapeutical application of VR for the treatment of mourning, are discussed.

Moral Distress and Moral Injury in Nephrology During the COVID-19 Pandemic

Summary: Across the world, challenges for clinicians providing health care during the coronavirus disease 2019 (COVID-19) pandemic are highly prevalent and have been widely reported. Perspectives of provider groups have conveyed wide-ranging experiences of adversity, distress, and resilience. In understanding and responding to the emotional and psychological implications of the pandemic for renal clinicians, it is vital to recognize that many experiences also have been ethically challenging. The COVID-19 pandemic has prompted rapid and extensive transformation of health care systems and widely impacted care provision, heightening the risk of barriers to fulfillment of ethical duties. Given this, it is likely that some clinicians also have experienced moral distress, which can occur if an individual is unable to act in accordance with their moral judgment owing to external barriers. This review presents a global perspective of potential experiences of moral distress in kidney care during the COVID-19 pandemic. Using nephrology cases, we discuss why moral distress may be experienced by health professionals when withholding or withdrawing potentially beneficial treatments owing to resource constraints, when providing care that is inconsistent with local prepandemic best practice standards, and when managing dual professional and personal roles with conflicting responsibilities. We argue that in addition to responsive and appropriate health system supports, resources, and education, it is imperative for health care providers to recognize and prevent moral distress to foster the psychological well-being and moral resilience of clinicians during extended periods of crisis within health systems.

Pandemic Grief Scale in detection of grief reaction among physicians in COVID-19 era

Background

Physicians are considered one of the most vulnerable groups who might develop pandemic grief during this critical time of COVID-19 infection, and this grief reaction might have deleterious effects on their life. This cross-sectional observational online study aimed to investigate the pandemic grief reaction among physicians and its burden on their aspects of life.

Results

Socio-demographic characteristics of 900 physicians were collected. The Pandemic Grief Scale (PGS) was used to detect the grief reaction among them and also Patient Health Depression Questionnaire-9 (PHQ-9) was used to evaluate the depressive manifestations. Sheehan Disability Scale was considered to investigate the burden of this grief on different aspects of life. The study revealed high mean score of Pandemic Grief Scale: 11.12 ± 2.34; the mean score of Sheehan Disability Scale was 17.63 ± 5.17, and the mean score of Patient Health Depression Questionnaire-9 was 19.89 ± 4.27.

Conclusion

Pandemic grief is commonly experienced by the physicians during this COVID-19 era due to sudden loss of loved one or the cases themselves. This pandemic grief has drastic effect on domains of physicians’ life.

Challenges of paediatric palliative care in the intensive care unit during the COVID-19 pandemic

BACKGROUND

The integration of paediatric palliative care into the Iranian health system is essential.

AIMS

The aim of this study was to identify the challenges of palliative care in the paediatric intensive care unit during COVID-19 through the experiences of healthcare providers.

METHODS

A qualitative study with content analysis approach was conducted. Fifteen physicians and nurses were selected by purposeful sampling. The semi-structured, in-depth interviews were applied in the data collection.

FINDINGS

Ten main categories were extracted from data analysis, including 'caring in COVID-19', 'communication and family centre care', 'breaking bad news', palliative care training', 'pain and symptom management', 'support of the child, family and clinical team', 'physical environment', 'guidelines', 'specialised staff' and 'home based palliative care'.

CONCLUSION

Palliative care in the PICU faces several challenges, especially during COVID-19, but the clinical team are making every attempt to improve the comprehensive care of children and their families. Telehealth is important in COVID-19, and education is also a key component to improve palliative care in the PICU in Iran.

COVID-19 and family violence: Is this a perfect storm?

Disasters including public health crises like the COVID-19 pandemic are known to increase instances of family violence against women, children, and other diverse populations. This paper discusses and provides evidence of disaster-related vulnerability of and violence towards specific groups of people. We argue that the COVID-19 pandemic presents the 'perfect storm' for family violence, where a set of rare circumstances combine, resulting in a significant aggravation of the resulting event. Given the mental health implications of family violence, mental health professionals need to be aware of this issue during the pandemic and ready to assist with the development of strategies to overcome the situation where possible. To provide protection and prevent violence, there is a need to include at-risk groups in disaster response and community planning. Such a plan could involve gender and disaster working groups at the local community, state, and national levels.