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Carroll HK, Broderick A, McCarthy O, Bambury RM, Power DG, Collins DC, Connolly RM, Noonan SA, Collins D, Cunningham E, Kennedy M, O'Driscoll K, Nuzum D, Twomey K, O'Riordan A, O'Sullivan F, Roe C, Lowney AC, O'Leary MJ, O'Reilly S. Room to Improve: An Audit of In-Hospital End-of-Life Care for Oncology Patients in a Tertiary Cancer Centre in Ireland During the COVID-19 Pandemic. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231196620. [PMID: 37670454 DOI: 10.1177/00302228231196620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
The COVID-19 pandemic compounded isolation for patients through social distancing measures and staff shortages. We were concerned about the impact of COVID-19 on the quality of care provided at end-of-life in 2021 in a national cancer centre, and instigated the first ever review of the care of the dying. Quality of care was assessed retrospectively using a validated instrument developed by the United Kingdom's National Quality Board. Sixty-six patient deaths occurred in our cancer centre in 2021. The 'risk of dying' was documented in 65.2% of records. Palliative care services were involved in 77%, and pastoral care in 10.6%. What was important to the patient was documented in 24.2%. The 'quality-of-death' score was satisfactory for most but poor in 21.2%. Our study prompted change, including appointment of an end-of-life coordinator, development of a checklist to ensure comprehensive communication, expansion of the end-of-life committee to include junior doctors, and regular audit.
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Affiliation(s)
| | | | - Orfhlaith McCarthy
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | - Richard M Bambury
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | - Derek G Power
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | - Dearbhaile C Collins
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | - Roisin M Connolly
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | - Sinead A Noonan
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | | | - Elaine Cunningham
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | - Mary Kennedy
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | | | - Daniel Nuzum
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | | | | | | | | | - Aoife C Lowney
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | - Mary Jane O'Leary
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | - Seamus O'Reilly
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
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Arbour RB, Wiegand DL. Self-described Nursing Responses Experienced During Care of Dying Patients and Their Families: A Phenomenological Study. J Hosp Palliat Nurs 2023; 25:E49-E56. [PMID: 36763060 DOI: 10.1097/njh.0000000000000936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Critical care nurses care for dying patients and their families. Little is known about the feelings and experiences of critical care nurses and how they are affected when they provide end-of-life care. Study purpose was to understand lived experiences, responses, and feelings of critical care nurses providing end-of-life care. A descriptive phenomenological design with purposive sampling was used to recruit 19 critical care nurses who cared for dying patients and their families. Interviews were recorded and transcribed verbatim. Nurses were asked open-ended questions about experiences and responses while providing end-of-life care. Coliazzi's method of data analysis was used to inductively determine themes, clusters, and categories. Data saturation was achieved, and methodological rigor was established. Responses included personalizing the experience, sadness, ageism, anger, frustration, relief, and stress. Factors contributing to clinicians' lived experience included previous experiences with death affecting how the experience was personalized among others. Critical care nurses may be unprepared for feelings and responses encountered during end-of-life care. Preparation for feelings and responses encountered during end-of-life care in nursing education and critical care orientation classes is essential. Future research should study optimal mentoring, teaching, and preparation for providing optimal end-of-life care. Study results have implications for practice, education, and research.
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Hanauer C, Telaar B, Al-Dawaf N, Rosner R, Doering BK. 'Feeling disconnected' - risk factors for PGD and themes in grief counselling during the COVID-19 pandemic. A mixed-method study. Eur J Psychotraumatol 2023; 14:2183006. [PMID: 36912798 PMCID: PMC10013402 DOI: 10.1080/20008066.2023.2183006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Background: Due to its high death toll and measures to curb the pandemic, COVID-19 has affected grieving experiences and may contribute to risk factors for Prolonged Grief Disorder (PGD). Persons at risk for PGD often seek support from grief counselling.Objective: To explore whether pandemic-associated risk factors have become more important topics in counselling in a mixed-method design.Method: German grief counsellors (n = 93) rated whether pre-defined risk factors had become more important in grief counselling and indicated additional important themes in an open format.Results: The counsellors indicated that all pre-defined risk factors had become more important, though differing significantly in their frequency. Most frequently endorsed risk factors were lack of social support, limited possibilities to accompany a dying loved one and absence of traditional grief rituals. Qualitative analysis identified three additional themes: the societal impact of the pandemic, its impact on bereavement support and health care, and a chance for personal growth.Conclusions: The pandemic has affected bereavement experiences and grief counselling. Counsellors should monitor grief processes and specific risk factors to provide the best possible care for bereaved people when needed.
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Affiliation(s)
- Christina Hanauer
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Berit Telaar
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Nadja Al-Dawaf
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Bettina K Doering
- Clinical Psychology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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van Schaik T, Brouwer MA, Knibbe NE, Knibbe HJJ, Teunissen SCCM. The Effect of the COVID-19 Pandemic on Grief Experiences of Bereaved Relatives: An Overview Review. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221143861. [PMID: 36453639 PMCID: PMC9720061 DOI: 10.1177/00302228221143861] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The COVID-19 pandemic has disrupted grief experiences of bereaved relatives and altered accustomed ways of coping with loss. To understand how bereaved relatives experienced grief during COVID-19, a review, using the overview method, was conducted. An overview of empirical data about this subject has been lacking and therefore, PubMed and CINAHL databases were searched for empirical studies published from January 1, 2020 until December 31, 2021. 28 articles were included in the review. Thematic analysis showed different emotional responses, changes in grief, the effect of absence during final moments, a lack of involvement in the caring process, the impact on communities and social support systems and the alteration of funerals among bereaved relatives. During COVID-19, death is characterized by poor bereavement outcomes and health implications, but bereaved also show signs of resilience and coping. Directions for future research about cultural and societal differences in grief and support methods are suggested.
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Affiliation(s)
- Tamara van Schaik
- Julius Center for Health Sciences
and Primary Care, University Medical Center
Utrecht, Utrecht, The Netherlands
| | - Marije A. Brouwer
- Julius Center for Health Sciences
and Primary Care, University Medical Center
Utrecht, Utrecht, The Netherlands
| | | | | | - Saskia C. C. M. Teunissen
- Julius Center for Health Sciences
and Primary Care, University Medical Center
Utrecht, Utrecht, The Netherlands
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