“I can’t make all this work.” End of life care provision in natural disasters: a qualitative study

Abstract

Background Natural disasters are becoming more frequent and severe and profoundly impact the end-of-life care experience, including service provision. There is a paucity of research examining healthcare workers’ experiences in responding to care demands when disasters strike. This research aimed to fill this gap by exploring end-of-life care providers’ perceptions of the impact of natural disasters on end-of-life care. Methods Between Feb 2021-June 2021 ten in-depth semi-structured interviews were conducted with healthcare professionals providing end-of-life care during recent natural disasters, COVID-19, and/or fires and floods. Interviews were audio-recorded, transcribed, and analysed using a hybrid inductive and deductive thematic approach. Results The overarching theme from the healthcare workers’ accounts was of being unable to provide effective compassionate and quality care - “I can’t make all this work.” They spoke of the considerable burdens the system imposed on them, of being overextended and overwhelmed, having their roles overturned, and losing the human element of care for those at end-of-life. Conclusion There is urgent need to pioneer effective solutions to minimise the distress of healthcare professionals in delivering end-of-life care in disaster contexts, and to improve the experience of those dying.

Bolstering health systems to cope with the impacts of climate change events: A review of the evidence on workforce planning, upskilling, and capacity building

“…However, only nine studies 26,28,35,37,44,64,65,69,70 in this theme discussed a training programme that had been implemented, highlighting that existing climate training and education for the health workforce is limited. Under planning for staff surge capacity, 4,5,8,10,14,27,28,30,31,[33][34][35][36]38,39,[41][42][43][44][45][46][47][48][49][50][53][54][55][56][57][59][60][61][62]67,70,72,[74][75][76] discussions centred on rostering considerations and contingency plans to ensure workforce surge capacity, as well...…”

“…Thirty-nine studies reported on the impacts of climate change on the health workforce, with four main themes identified (Table 3). The most common theme in this category was the experience of system breakdown (n = 20), 4,8,10,14,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] due to unclear allocation of staff roles and remuneration, electrical outages, and inadequate processes and preparation in healthcare facilities. This was often observed alongside unsafe conditions (n = 16) studies, 10,13,28,29,37,41-51 in which the workforce was exposed to building damages, infectious diseases, and reduced T A B L E 2 Characteristics of included studies.…”

“…Only 23% of publications discussed providing psychological support and when support was provided, this was often informal, ad hoc, 41 or a suggestion that psychological support should be provided to staff in the future. 39,51 Only one publication included in our review described a clear psychological support programme, 'Wellness Warriors', that was established as a peer-based initiative to support colleagues in times of crisis. 69 However, there were concerns about the sustainability of Wellness Warriors and the ongoing support from healthcare leadership was seen as crucial if it was to continue providing vital support.…”

“…Role flexibility or role substitution, in which staff took on tasks outside of their usual job description or scope of practice to cope with increased patient surges, was discussed in 16 studies. 14,28,30,31,33,36,37,39,41,44,51,53,54,59,66,74 The provision of psychological support for the workforce was another important theme, with 14 studies 4,8,9,39,41,44,48,[51][52][53][54]56,66,69 highlighting the importance of looking after workers' mental wellbeing; for example, through the provision of counselling during and after climate events or reshaping rosters to ensure staff had adequate time to rest. Twelve studies discussed additional role incentives.…”

“…4,8,46 One paper highlighted that staff felt they were 'carrying the brunt of the system's inability to deliver usual care'. 39 Despite this commitment and dedication of staff to continue working during unprecedented demands for care and often whilst struggling to obtain needed resources to deliver care, sometimes in unsafe conditions, publications highlighted the lack of additional financial remuneration or incentives above the usual pay-rate, to compensate staff during crises. Several publications highlighted that staff would continue to work because of their intrinsic sense of professional duty, work ethic and workplace culture focussed on serving the community despite a lack of remuneration.…”