Complexity of Nurse Practitioners’ Role in Facilitating a Dignified Death for Long-Term Care Home Residents during the COVID-19 Pandemic

Abstract

Due to the interplay of multiple complex and interrelated factors, long-term care (LTC) home residents are increasingly vulnerable to sustaining poor outcomes in crisis situations such as the COVID-19 pandemic. While death is considered an unavoidable end for LTC home residents, the importance of facilitating a good death is one of the primary goals of palliative and end-of-life care. Nurse practitioners (NPs) are well-situated to optimize the palliative and end-of-life care needs of LTC home residents. This study explores the role of NPs in facilitating a dignified death for LTC home residents while also facing increased pressures related to the COVID-19 pandemic. The current exploratory qualitative study employed a phenomenological approach. A purposive sample of 14 NPs working in LTC homes was recruited. Data were generated using semi-structured interviews and examined using thematic analysis. Three categories were derived: (a) advance care planning and goals of care discussions; (b) pain and symptom management at the end-of-life; and (c) care after death. The findings suggest that further implementation of the NP role in LTC homes in collaboration with LTC home team and external partners will promote a good death and optimize the experiences of residents and their care partners during the end-of-life journey.

The Future Includes Nurse Practitioner Models of Care in the Long-Term Care Sector

“…The removal of restrictions to NP practice did not result in any known negative outcomes. Conversely, during COVID-19, NPs contributed to positive outcomes such as successfully diagnosing and treating residents in place 28 ; minimizing adverse outcomes of residents and ensuring dignified deaths 31 ; establishing links between fragmented systems of care; coordinating and implementing care pathways with acute care facilities; developing resources, such as flow sheets outlining the process of consulting with specialists; and developing programs for virtual visits with these specialists. 27 NPs working in the LTC sector as PCPs throughout the pandemic consulted and collaborated with physicians, specialists, and other external stakeholders to ensure optimal resident care was received.…”

Nurse Practitioners Navigating the Consequences of Directives, Policies, and Recommendations Related to the COVID-19 Pandemic in Long-Term Care Homes

“…As long-term care (LTC) homes were disproportionately affected by the Coronavirus Disease 2019 (COVID-19) pandemic ( Stall et al, 2021 ), it was critical to develop solutions addressing the challenges facing resident care in this sector. The essential role of Nurse Practitioners (NPs) has been greatly underscored during the COVID-19 pandemic as a lynchpin to quality in LTC homes ( Rosa et al, 2020 ; Vellani et al, 2021 ). NPs are graduate-trained advanced practice nurses, who work in diverse healthcare settings, including LTC homes ( International Council of Nurses [ICN], 2018 ).…”

“…The scope of practice of NPs in the United States was similarly extended through flexibility in regulation ( Thomas-Gayle & Muller, 2021 ). NPs continued to deliver positive resident outcomes during the COVID-19 pandemic notwithstanding the expansion in their scope of practice and responsibilities ( McGilton et al, 2021 ; Mileski et al, 2020 ; Vellani et al, 2021 ).…”

“…Underscoring their integral role, NPs stepped in to minimize the suffering of residents, moral distress of staff, and grief experienced by families. In close collaboration with LTC home staff, NPs provided comprehensive care to residents including timely advance care planning and goals of care discussions; palliative and end-of-life care; as well as facilitated virtual visits with physician specialists ( Diez-Sampedro et al, 2020 ; McGilton et al., 2021 ; Vellani et al, 2021 ). Thus, the regulatory changes enacted during the pandemic expanded the practice authority of NPs, and testified anew to their capacity to function as exemplary independent clinicians who are effective in promoting interdisciplinary collaboration and ensuring high quality care for LTC home residents ( O’Reilly-Jacob et al., 2022 ).…”

“…As a myriad of chronic structural and systemic issues in the LTC sector have been brought into focus throughout the COVID-19 pandemic ( McGilton et al, 2020 ), the ongoing challenges faced by the LTC workforce in providing optimal care for residents with complex needs continued to be highlighted. In an effort to elucidate these challenges, during wave one of the pandemic we conducted interviews with NPs to describe their experience in LTC homes, and the results have been published elsewhere ( McGilton et al, 2021 ; Vellani et al., 2021 ). Although the role of NPs and their positive influence on outcomes during the first wave of COVID-19 pandemic has been articulated in previous work, the NPs’ contribution during the subsequent wave was less clear.…”