Clinician Perspectives on Caring for Dying Patients During the Pandemic

Cook, Deborah J.; Takaoka, Alyson; Hoad, Neala; Swinton, Marilyn; Rudkowski, Jill; Heels‐Ansdell, Diane; Boyle, Anne; Toledo, Feli; Dennis, Brittany B.; Fiest, Kirsten M.; Vanstone, Meredith

doi:10.7326/m20-6943

Cited by 49 publications

(55 citation statements)

References 44 publications

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“…The COVID-19 pandemic has also placed a heavy toll on healthcare professionals, who grappled with fatigue while navigating unfamiliar virtual modalities (to connect competent patients with their loved ones), cared for their own colleagues who fell ill, and comforted dying, isolated patients [ 32 ]. However, caring for patients at the end of life, clinicians also expressed their humanity, tried to ensure dignity-conserving care, adopt new roles, and catalyze connections [ 33 ]. More data on the impact of the COVID-19 pandemic on patients and families is needed to inform healthcare professionals how to better care for patients, with attention to promoting patient- and family-centred care and mitigate against potential health inequities [ 32 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…Despite intentions to ensure patient, family and healthcare professional safety, there is a growing body of evidence suggesting that restricted visitation policies enacted in acute care settings due to the COVID-19 pandemic have had unintended consequences warranting further exploration [ 16 – 20 ]. The purpose of this scoping review is to synthesize the literature reporting on restricted visitation policies in acute care settings enacted because of the COVID-19 pandemic, describe perspectives on and impacts of restricted visitation policies among patients, families, and healthcare professionals, and identify mitigation approaches aimed at improving patient- and family-centred care during periods of restricted visitation.…”

Section: Introductionmentioning

confidence: 99%

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Restricted visitation policies in acute care settings during the COVID-19 pandemic: a scoping review

et al. 2021

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Background Restricted visitation policies in acute care settings because of the COVID-19 pandemic have negative consequences. The objective of this scoping review is to identify impacts of restricted visitation policies in acute care settings, and describe perspectives and mitigation approaches among patients, families, and healthcare professionals. Methods We searched Medline, Embase, PsycINFO, Healthstar, CINAHL, Cochrane Central Register of Controlled Trials on January 01/2021, unrestricted, for published primary research records reporting any study design. We included secondary (e.g., reviews) and non-research records (e.g., commentaries), and performed manual searches in web-based resources. We excluded records that did not report primary data. Two reviewers independently abstracted data in duplicate. Results Of 7810 citations, we included 155 records. Sixty-six records (43%) were primary research; 29 (44%) case reports or case series, and 26 (39%) cohort studies; 21 (14%) were literature reviews and 8 (5%) were expert recommendations; 54 (35%) were commentary, editorial, or opinion pieces. Restricted visitation policies impacted coping and daily function (n = 31, 20%) and mental health outcomes (n = 29, 19%) of patients, families, and healthcare professionals. Participants described a need for coping and support (n = 107, 69%), connection and communication (n = 107, 69%), and awareness of state of well-being (n = 101, 65%). Eighty-seven approaches to mitigate impact of restricted visitation were identified, targeting families (n = 61, 70%), patients (n = 51, 59%), and healthcare professionals (n = 40, 46%). Conclusions Patients, families, and healthcare professionals were impacted by restricted visitation polices in acute care settings during COVID-19. The consequences of this approach on patients and families are understudied and warrant evaluation of approaches to mitigate their impact. Future pandemic policy development should include the perspectives of patients, families, and healthcare professionals. Trial registration: The review was registered on PROSPERO (CRD42020221662) and a protocol peer-reviewed prior to data extraction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Restricted visitation policies in acute care settings during the COVID-19 pandemic: a scoping review

et al. 2021

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“…( Anderson-Shaw and Zar, 2020 , Hickman and Douglas, 2010 , World Health Organization (WHO) 2020 , CASP 2020 , Cook et al, 2020 )…”

Section: Uncited Referencesmentioning

confidence: 99%

Consequences of visiting restrictions during the COVID‐19 pandemic: An integrative review

Hugelius

Harada

Marutani

2021

International Journal of Nursing Studies

266

207

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Background During the COVID-19 pandemic, visiting restrictions of different extents have been implemented. However, despite the long history of visiting restrictions in health care systems, little is known about their effects. Objectives This review sought to explore the consequences of visitor restrictions in health care services during the COVID-19 pandemic. Methods A systematic, integrative review was conducted in accordance with the PRISMA guidelines, based on a systematic search in PubMed, CHINAL full plus, Web of Science, PsychInfo, Scopus and the Cochrane Library. Results A total of 17 scientific papers covering intensive care, paediatric care, general medical care, hospital care, palliative care and nursing home settings were included. Although appreciation for the technical solutions enabling remote meetings was reported, visiting restrictions had several consequences, mainly negative, for the patient's health, the health and wellbeing of family members and the provision of care. Among physical health consequences, reduced nutrition intake, decreased activities of daily living and increased physical pain and symptoms were reported. Among mental health consequences for the patient, loneliness, depressive symptoms, agitation, aggression, reduced cognitive ability and overall dissatisfaction were observed. For family members, worry, anxiety and uncertainty occurred, and they reported an increased need for information from care providers. Family members of neonatal intensive care unit patients reported less bonding with their child and family relation disturbances due to the restrictions. For care providers, visiting restrictions added the burdens of ethical dilemmas, learning new technical means to enable social interaction and an increased demand for communication with families and providing social support to both family members and patients. Conclusions When implementing visiting restrictions in health care services, decision makers and nurses need to be aware of their potential negative effects and adapt the provision of care to compensate for such effects. Nurses in all sectors should be aware that visiting restrictions may affect patients, families, and health care services for longer than the actual pandemic. Since the level of evidence regarding effect from visiting restrictions is low, further studies is strongly needed.

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“…Because prior studies have demonstrated many positive influences of the 3WP ( 13 – 15 ), we did not evaluate its effect on families during this study period, acknowledging the possibility that the 3WP was particularly valuable due to the tragic circumstances of the pandemic. The ability to provide compassionate care can help alleviate HCWs’ distress and enhance interpersonal connections during these unprecedented times ( 41 , 43 , 44 ) although this was not measured in this study. Although changes noted over time may plausibly reflect program maturation, baseline data allowed comparisons with prepandemic circumstances, which is rare in studies of EOL interventions during the pandemic.…”

Section: Discussionmentioning

confidence: 99%

End-of-Life Care During the Coronavirus Disease 2019 Pandemic: The 3 Wishes Program

Neville

Bear²,

Kao³

et al. 2021

Critical Care Explorations

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Clinician Perspectives on Caring for Dying Patients During the Pandemic

Abstract: The COVID-19 pandemic is changing the way we provide end-of-life care for patients who are in the hospital. This article documents how those changes are affecting nurses, physicians, and other hospital caregivers, using their own words.

Cited by 49 publications

References 44 publications

Restricted visitation policies in acute care settings during the COVID-19 pandemic: a scoping review

Restricted visitation policies in acute care settings during the COVID-19 pandemic: a scoping review

Consequences of visiting restrictions during the COVID‐19 pandemic: An integrative review

End-of-Life Care During the Coronavirus Disease 2019 Pandemic: The 3 Wishes Program

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