The end of life of patients with COVID-19 in intensive care unit and the stress level on their family members: A cross-sectional study

Challenges of using body bags for COVID-19 deaths from the healthcare provider perspective - a qualitative study

BACKGROUND

During the COVID-19 pandemic, numerous issues regarding end-of-life care for COVID-19 patients have been discussed. Among these issues, challenges related to the use of body bags following the death of COVID-19 patients have been suggested. This study aimed to identify the challenges faced by healthcare professionals (HCPs) when using body bags after the death of patients infected with COVID-19 in medical settings.

METHODS

We conducted a qualitative descriptive study with semistructured in-depth interviews using inductive thematic analysis. From August to December 2021, we interviewed nurses and doctors who provided end-of-life care to COVID-19 patients focusing on their experiences with the use of body bags for the deceased.

RESULTS

Of the 25 interviewees who mentioned body bag use, 14 were nurses (56%) and 13 were women (52%). The mean interview length was 52.0 min (SD 9.6 min). Challenges associated with body bag use were classified into four themes with eight categories: preserving the dignity of the deceased, consideration for the bereaved saying a final goodbye to a loved one in a body bag, the physical and emotional impact on HCPs, and diverse opinions on body bag use.

CONCLUSION

Our findings include ethical concerns about the dignity of the deceased, empathy for the grief of bereaved families, and the emotional and physical distress experienced by HCPs struggling with the recommendation to use body bags based on limited evidence. The diverse perspectives of HCPs in this study highlight potential issues that developers should consider when formulating more appropriate and acceptable guidelines/guidance and policies.

Healthcare System Digital Transformation across Four European Countries: A Multiple-Case Study

Digitization has become involved in every aspect of life, including the healthcare sector with its healthcare professionals (HCPs), citizens (patients and their families), and services. This complex process is supported by policies: however, to date, no policy analysis on healthcare digitalization has been conducted in European countries to identify the main goals of digital transformation and its practical implementation. This research aimed to describe and compare the digital health policies across four European countries; namely, their priorities, their implementation in practice, and the digital competencies expected by HCPs. A multiple-case study was performed. Participants were the members of the Digital EducationaL programme invoLVing hEalth profEssionals (DELIVER), a project funded by the European Union under the Erasmus+ programme, involving three countries (Denmark, Italy, and Slovenia) and one autonomous region (Catalonia-Spain). Data were collected using two approaches: (a) a written interview with open-ended questions involving the members of the DELIVER project as key informants; and (b) a policy-document analysis. Interviews were analysed using the textual narrative synthesis and the word cloud policy analysis was conducted according to the Ready, Extract, Analyse and Distil approach. Results showed that all countries had established recent policies at the national level to address the development of digital health and specific governmental bodies were addressing the implementation of the digital transformation with specific ramifications at the regional and local levels. The words "health" and "care" characterized the policy documents of Denmark and Italy (309 and 56 times, 114 and 24 times, respectively), while "development" and "digital" (497 and 478 times, respectively) were common in the Slovenia document. The most used words in the Catalonia policy document were "data" and "system" (570 and 523 times, respectively). The HCP competencies expected are not clearly delineated among countries, and there is no formal plan for their development at the undergraduate, postgraduate, and continuing educational levels. Mutual understanding and exchange of good practices between countries may facilitate the digitalization processes; moreover, concrete actions in the context of HCP migration across Europe for employment purposes, as well as in the context of citizens' migration for healthcare-seeking purposes are needed to consider the differences emerged across the countries.

Thematic analysis of intensive care unit diaries kept by staff: insights for caring

OBJECTIVE

To explore recurrent themes in diaries kept by intensive care unit (ICU) staff during the coronavirus disease 2019 (COVID-19) pandemic.

DESIGN

Qualitative study.

SETTING

Two ICUs in a tertiary level hospital (Milan, Italy) from January to December 2021.

METHODS

ICU staff members wrote a digital diary while caring for adult patients hospitalized in the intensive care unit for >48 hours. A thematic analysis was performed.

FINDINGS

Diary entries described what happened and expressed emotions. Thematic analysis of 518 entries gleaned from 48 diaries identified four themes (plus ten subthemes): Presenting (Places and people; Diary project), Intensive Care Unit Stay (Clinical events; What the patient does; Patient support), Outside the Hospital (Family and topical events; The weather), Feelings and Thoughts (Encouragement and wishes; Farewell; Considerations).

CONCLUSION

The themes were similar to published findings. They offer insight into care in an intensive care unit during a pandemic, with scarce resources and no family visitors permitted, reflecting on the patient as a person and on daily care. The staff wrote farewell entries to dying patients even though no one would read them.

IMPLICATIONS FOR CLINICAL PRACTICE

The implementation of digital diaries kept by intensive care unit staff is feasible even during the COVID-19 pandemic. Diaries kept by staff can provide a tool to humanize critical care. Staff can improve their work by reflecting on diary records.

Implementation of video-calls between patients admitted to intensive care unit during the COVID-19 pandemic and their families: a pilot study of psychological effects

Background

The coronavirus disease 2019 (COVID-19) pandemic has caused over 530 million infections to date (June 2022), with a high percentage of intensive care unit (ICU) admissions. In this context, relatives have been restricted from visiting their loved ones admitted to hospital. This situation has led to an inevitable separation between patients and their families. Video communication could reduce the negative effects of such phenomenon, but the impact of this strategy on levels of anxiety, depression, and PTSD disorder in caregivers is not well-known.

Methods

We conducted a prospective study (6 October 2020–18 February 2022) at the Policlinico University Hospital in Catania, including caregivers of both COVID-19 and non-COVID-19 ICU patients admitted during the second wave of the pandemic. Video-calls were implemented twice a week. Assessment of anxiety, depression, and PTSD was performed at 1-week distance (before the first, T1, and before the third, video-call, T2) using the following validated questionnaires: Impact of Event Scale (Revised IES-R), Center for Epidemiologic Studies Depression Scale (CES-D), and Hospital Anxiety and Depression Scale (HADS).

Results

Twenty caregivers of 17 patients completed the study (T1 + T2). Eleven patients survived (n = 9/11 in the COVID-19 and n = 2/6 in the “non-COVID” group). The average results of the questionnaires completed by caregivers between T1 and T2 showed no significant difference in terms of CES-D (T1 = 19.6 ± 10, T2 = 22 ± 9.6; p = 0.17), HADS depression (T1 = 9.5 ± 1.6, T2 = 9 ± 3.9; p = 0.59), HADS anxiety (T1 = 8.7 ± 2.4, T2 = 8.4 ± 3.8; p = 0.67), and IES-R (T1 = 20.9 ± 10.8, T2 = 23.1 ± 12; p = 0.19). Similar nonsignificant results were observed in the two subgroups of caregivers (COVID-19 and “non-COVID”). However, at T1 and T2, caregivers of “non-COVID” patients had higher scores of CES-D (p = 0.01 and p = 0.04, respectively) and IES-R (p = 0.049 and p = 0.02, respectively), while HADS depression was higher only at T2 (p = 0.02). At T1, caregivers of non-survivors had higher scores of CES-D (27.6 ± 10.6 vs 15.3 ± 6.7, p = 0.005) and IES-R (27.7 ± 10.0 vs 17.2 ± 9.6, p = 0.03). We also found a significant increase in CES-D at T2 in ICU-survivors (p = 0.04).

Conclusions

Our preliminary results showed that a video-call implementation strategy between caregivers and patients admitted to the ICU is feasible. However, this strategy did not show an improvement in terms of the risk of depression, anxiety, and PTSD among caregivers. Our pilot study remains exploratory and limited to a small sample.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44158-022-00067-2.