Inadequate human resources, equipment and training: A qualitative assessment of the objectives of the NUHELP end-of-life care programme in the context of the COVID-19 pandemic

Abstract

Background: The COVID-19 pandemic had a particularly severe impact on nursing homes, exposing numerous pre-existing deficiencies in end-of-life care. Aim: To describe how the COVID-19 pandemic affected nursing home and primary care professionals’ attempts to achieve the objectives of a pre-existing end-of-life programme and to explore their personal experiences of end-of-life care in these facilities. Design: A qualitative descriptive study using thematic analysis. Setting/participants: Twenty semi-structured interviews were conducted from March to November 2020 with professionals from nursing homes and primary care facilities who participated in the development of the NUHELP programme. Results: Six main themes were identified: (1) Comprehensive assessments of residents at the homes were not conducted due to excessive workload and high staff turnover. (2) New technologies and changes to professional roles were used to meet relatives’ needs for information. Residents only received information when they requested it. (3) Advance care planning was not carried out and was limited to potential hospital transfer. (4) Arrangements were made to allow relatives to spend time with residents during their final moments, but complicated grief among relatives and professionals is anticipated. (5) Management of complexity varied depending on the degree of coordination with primary care facilities. (6) Nursing home professionals felt abandoned, with a lack of human resources, equipment and training. Conclusions: The pandemic cast light on existing shortcomings in nursing homes in terms of comprehensive assessments, communication, decision making, grief management and palliative care complexity. Nursing homes need more human, material and training resources, as well as improved coordination with the public healthcare system.

Attitudes and experiences related to the deaths of COVID‐19 patients among nursing staff: A qualitative evidence synthesis

“…In some cases, family members did not have the opportunity to say goodbye to the patient or had to say goodbye over the phone. This situation intensified the relationship between nurses and patients, as they did not have anyone else with them, resulted in the perception of patients dying alone, and professional healthcare workers consequently suffering burnout (Mota Romero et al, 2022). Both Montgomery et al (2021) and Wendlandt et al (2022) emphasize communication difficulties between healthcare staff and family members in the context of the COVID‐19 pandemic and the lack of understanding of family members about what was happening (Wendlandt et al, 2022).…”

“…The lack of staff training and experience was another Determining factor of care, potentially worsened by the lack of protocols and the overall lack of knowledge at the time regarding COVID‐19 (Mota Romero et al, 2022; Puente‐Fernández et al, 2020). Inadequate numbers of trained staff to attend to the high number of patients requiring care in the first waves of the pandemic made it impossible to provide high‐quality care.…”

“…Health systems became overwhelmed, prompting the development of new protocols in healthcare institutions, such as increasing the number of beds at several levels of care and employing staff with little to no experience in departments (Galanis et al, 2021; Mota Romero et al, 2022; Sahebi et al, 2021). The changes in healthcare units as a result of the pandemic contributed to healthcare staff developing stress, anxiety and depression (Adibi et al, 2021; Erquicia et al, 2020; Mota Romero et al, 2022; Poon et al, 2022; Sahebi et al, 2021; Ünver & Yeniğün, 2021). These changes made them feel helpless as they were unable to properly care for patients (Ashley et al, 2021; Poon et al, 2022; Torralba Melero et al, 2022).…”

Impact of the COVID-19 Pandemic on the Perceived Quality of Palliative Care in Nursing Homes

“…Strang et al [ 38 ] calculated that only 59% of those who died from COVID-19 were accompanied, either by professionals or family members. Despite the publication of regulations to prevent or limit the presence of relatives in nursing homes, the questionnaire responses indicated that these regulations were breached in order to facilitate the accompaniment of persons in their last days of life [ 39 , 40 ].…”

“…This question should be investigated further, given the need to ensure fluid collaboration between nursing homes and PHC workers and thus provide adequate end-of-life care. The multiple experiences of collaboration between professionals in both fields during the pandemic have brought positions closer in this regard, enabling PHC personnel to learn more about the work carried out in nursing homes [ 40 ].…”