A qualitative study of nursing practitioners' experiences with COVID-19 patients dying alone in Greece

Abstract

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.

Nurses’ Views on Caring for Lonely Patients During the Pandemic: A Qualitative Study

“…They provided care beyond limits, becoming, in some cases, the closest relative of the patient, supporting the patients who were dying alone and the families who were not able to say goodbye to their loved ones. Similar findings are reported in the relevant literature, as the absence of the family created new patterns in nurse-patient communication and developed strong bonding relationships between caregivers and patients [ 28 - 30 ]. Jia et al demonstrated that family visitation restrictions directed nurses towards offering a wide range of support to their isolated patients and adopting a mediating role between the patients and their families [ 31 ].…”

“…Deep and intense feelings of sadness and distress were experienced by the nurses as they were confronted with the patient, who was dying alone. This issue was discussed in the relevant literature by underscoring the need for the family to be next to the dying patient and the need for the dying patient to be surrounded by his/her relatives [ 30 - 33 ]. In consistency with the findings of the present study, Feder et al's study highlights the importance of sharing feelings of loss and mourning in cases where relatives were unable to be next to their loved ones even after death [ 34 ].…”

“…These relate to encouraging the family to participate in the patient's care plan, the reduction of patients’ negative emotions caused by isolation, as well as better prognosis and satisfaction from caring for the patients and their relatives [ 45 ]. Further to this, a flexible visitation policy was regarded as essential to alleviate stress and empower the patients, their families, and the nursing staff [ 30 ].…”

Nurses' bereavement experiences of a deceased colleague due to COVID‐19: A phenomenological study

“…Deaths in solitude are caused by the rules of isolation of COVID‐19 to prevent the spread of the virus. Such situations may have serious and unknown psychological consequences for family members and healthcare providers, such as feelings of helplessness, hopelessness, guilt, moral distress and long‐term, complicated grief (Voultsos et al, 2022). In a study, it is stated that dying alone is an unprecedentedly unbearable and devastating experience and is not compatible with what is called a “good death” (Voultsos et al, 2022).…”

“…Such situations may have serious and unknown psychological consequences for family members and healthcare providers, such as feelings of helplessness, hopelessness, guilt, moral distress and long‐term, complicated grief (Voultsos et al, 2022). In a study, it is stated that dying alone is an unprecedentedly unbearable and devastating experience and is not compatible with what is called a “good death” (Voultsos et al, 2022). But due to public health restrictions, patients die alone (Chochinov et al, 2020), and in this study, participants have stated that their colleagues died alone, which affected their mourning process.…”