Background Providing futile medical care is an ever-timely ethical problem in clinical practice. While nursing personnel are very closely involved in providing direct care to patients nearing the end of life, their role in end-of-life decision-making remains unclear. Methods This was a prospective qualitative study conducted with experienced nursing professionals from December 2020 through May 2021. Individual in-depth qualitative interviews were conducted with sixteen participants. We performed a thematic analysis of the data. Results Importantly, many participants were half-hearted in their attitude towards accepting or defining futile medical care. Furthermore, interestingly, a list of well-described circumstances emerged, under which the dying process is most likely to be a “bad and undignified” process. These circumstances reflected situations revolving around a) pain and suffering, b) treating patients with respect, c) the appearance and image of the patient body, and d) the interaction between patients and their relatives. Fear of legal action, the lack of a regulatory framework, physicians being pressured by (mostly uninformed) family members and physicians’ personal motives were reported as important reasons behind providing futile medical care. The nursing professional’s role as a participant in decisions on futile care and as a mediator between physicians and patients (and family members) was highlighted. Furthermore, the patient’s role in decisions on futile care was prioritized. The patient’s effort to keep themselves alive was also highlighted. This effort impacts nursing professionals’ willingness to provide care. Providing futile care is a major factor that negatively affects nursing professionals’ inner attitude towards performing their duties. Finally, the psychological benefits of providing futile medical care were highlighted, and the importance of the lack of adequately developed end-of-life care facilities in Greece was emphasized. Conclusions These findings enforce our opinion that futile medical care should be conceptualized in the strict sense of the term, namely, as caring for a brain-dead individual or a patient in a medical condition whose continuation would most likely go against the patient’s presumed preference (strictly understood). Our findings were consistent with prior literature. However, we identified some issues that are of clinical importance.

BackgroundIn Greece, there is still limited research on death in isolation due to COVID-19. This deserves attention because of the recent financial crisis, which profoundly impacted public health, and the high relevance of the Hippocratic tradition to the moral values of clinical practice.MethodsA prospective qualitative study using in-depth interviews with 15 frontline nursing practitioners working in a COVID-19 ward or intensive care unit (ICU) was conducted from July 2021 to December 2021.ResultsThe inability of family members to say a final goodbye before, during, or after death by performing proper mourning rituals is extremely inhuman and profoundly impacts the mental health status of patients, family members, and nursing practitioners. Patients and their family members strongly desire to see each other. Epidemiology, liability, and proper nursing performance emerged as reasons for the enforced strict visitation restrictions. Participants emphasized that visitations should be allowed on an individual basis and highlighted the need for the effective use of remote communication technology, which, however, does not substitute for in-person contact. Importantly, physicians allowed “clandestine” visits on an individual basis. Nursing practitioners had a strong empathic attitude toward both patients and their families, and a strong willingness to provide holistic care and pay respect to dead bodies. However, they also experienced moral distress. Witnessing heartbreaking scenes with patients and/or their families causes nursing practitioners to experience intense psychological distress, which affects their family life rather than nursing performance. Ultimately, there was a shift from a patient-centered care model to a population-centered care model. Furthermore, we identified a range of policy- and culture-related factors that exaggerate the negative consequences of dying alone of COVID-19.ConclusionThese results reinforce the existing literature on several fronts. However, we identified some nuances related to political decisions and, most importantly, convictions that are deeply rooted in Greek culture. These findings are of great importance in planning tailored interventions to mitigate the problem of interest and have implications for other similar national contexts.

BackgroundDying in isolation and without saying a goodbye before, during and after death causes patients, families and health providers to suffer greatly. In Greece, there is still limited knowledge about dying in isolation as perceived by frontline nursing practitioners working in a COVID-19 ward or ICU. Nursing practitioners spend a lot of time near their patients. Greece is most vulnerable country to the international problem of dying in isolation during the COVID-19 pandemic. MethodsA prospective qualitative study using in-depth interviews with fifteen frontline nursing practitioners working in a COVID-19 ward or ICU was conducted from July 2021 through December 2021. We performed a thematic analysis of the data. ResultsDying in isolation without saying a goodbye before, during or after death emerged as an extremely inhuman experience that critically ill covid patients and their loved ones had to go through. Fear of spreading COVID-19 infection, fear of liability, and fear of hindering the performance of nursing duties were emerged as main reasons behind strict visitation restrictions. Patients and family members were reported to have expressed very strong desire to communicate and interact with each other. Most participants were shown to be with high levels of empathy, willingness to provide holistic care. Furthermore, most participants were shown to be with high levels of psychological and moral distress. All participants held that visitations should be allowed on an individual basis, and remote communication technology should be available to any covid patient. Importantly, it was identified in this study that physicians’ and nursing practitioners’ discretion and goodwill can significantly mitigate the problem of dying alone. In some COVID-19 health care settings visitations were allowed at physicians’ discretion. These “clandestine” visitations were mentioned as practices that existed in reality, even though they were not officially recognized by the Greek rules. Furthermore, the quality of nursing care seemed to have shifted towards a broader definition. Political neglect was a factor that emerged as a major factor that enlarges the problem of dying in isolation. Finally, and most importantly, a shift towards a less patient-centered model of care was emerged from the data analysis. ConclusionThe results reinforce the existing literature on many fronts. However, we identified some nuances that are of great importance in planning tailored interventions to mitigate the problems related to dying in isolation from COVID-19, and most importantly, hold down the commonly accepted patient-centered model of care. On the account of the patient-centered model of care and the modern (broad, positive-holistic) concept of health, providing holistic care for critically ill covid patients is both an institutional duty and a moral obligation.

Background Providing futile medical care is an ever timely ethical problem in clinical practice. While nursing personnel are very closely involved in providing direct care to patients nearing the end of life, their role in end-of-life decision making remains unclear. Methods This is a prospective qualitative study conducted with experienced nursing professionals from December 2020 through May 2021. Individual in-depth qualitative interviews were conducted with sixteen participants. We performed a thematic analysis of the data. Results Importantly, many participants were half-hearted in their attitude towards accepting or defining futile medical care. Furthermore, interestingly, emerged a list of well-described circumstances, under which the dying process is most likely to be a “bad and undignified” process. These circumstances reflected situations revolving around: a) pain and suffering, b) treating patients with respect, c) the appearance and image of the patient body, and d) the interaction between patients and their relatives. Fear of legal action, lack of regulatory framework, physicians pressured from (mostly uninformed) family members and physicians’ personal motives were reported as important reasons behind providing futile medical care. It is highlighted the nursing professional’s role as participant in decisions on futile care and as mediator between physicians and patients (and family members). Furthermore, it is prioritized the patient’s role in decisions on futile care. It is highlighted the impact of patient’s effort to keep themselves alive on nursing professionals’ willingness to provide care. Providing futile care is a major factor that negatively affects the nursing professionals’ inner attitude towards performing their duties. Finally, the psychological benefits of providing a futile medical care are highlighted, and the importance of the lack of adequately developed end-of-life care facilities in Greece is emphasized. Conclusions These findings enforce our opinion that futile medical care should be conceptualized in the strict sense of the term, namely, as caring for a brain-dead individual or a patient in a medical condition whose continuation would most likely go against the patient’s presumed preference (strictly understood). For a great part, our findings were consistent with prior literature. However, we identified some issues that are of clinical importance.