Older patients’ perspectives on illness and healthcare during the early phase of the COVID-19 pandemic

Abstract

Background Equal access to healthcare is a core principle in Norway’s public healthcare system. The COVID-19 pandemic challenged healthcare systems in the early phase – in particular, related to testing and hospital capacity. There is little knowledge on how older people experienced being infected with an unfamiliar and severe disease, and how they experienced the need for healthcare early in the pandemic Aim To explore the experiences of older people infected by COVID-19 and their need for testing and hospitalisation. Research design An explorative and descriptive approach, with qualitative interviews conducted in October 2020. Participants and research context Seventeen participants above 60 years of age hospitalised due to COVID-19 during spring 2020 were recruited 6 months after discharge. Ethical considerations Ethical approval was granted by the Regional Committee for Medical and Health Research Ethics in South-Eastern Norway (155425). Findings The main finding was that the informants experienced vulnerability and arbitrariness. This finding was supported by three sub-themes: experiences with a severe and unfamiliar disease, the strict criteria and the importance of someone advocating needs. Discussion Participants described varying access to healthcare. Those who did not meet the national criteria to be tested or hospitalised struggled against the system. Findings reveal arbitrary access to healthcare, in contrast to Norway’s ethical principle of fair and just access to health services. Moreover, to access and receive necessary healthcare, informants were dependent on their next-of-kin’s advocacy. Conclusion Even when dealing with an unfamiliar disease, health professionals’ assessments of symptoms must be performed with an ethical obligation to applicate competent appraisal and the exercise of discernment; this is in line with care ethics and ethical standards for nurses. These perspectives are a significant part of caring and the intension of doing good.

‘A Story of Being Invisible’: A Single Case Study on the Significance of Being Recognised When Needing Acute Healthcare in the Early COVID-19 Pandemic

“…Context is not just organisational structure or physical entities but includes features that shape relations and interactions ( May et al, 2016 ), and identifying contextual aspects of relational interactions contributes to describing the complexity of practice ( Nicolini, 2012 ). Anne made several attempts to access necessary medical information and/or treatment but struggled to pass the strict gatekeepers as she didn’t meet ‘the strict national corona criteria’ ( Jøranson et al, 2022 ). The challenge of testing ill patients and the adherence to strict priorities due to fear of overloading the hospital wards are other contextual aspects in this story, and these were communicated strictly monologically from the macro level to be handled on a micro level by healthcare personnel ( NOU2021:6 ).…”

“…Encounters between patients and providers early in the pandemic were characterised by lack of knowledge on how to treat COVID-19, nervous patients, stressed healthcare personnel, lack of overview, etc., factors which probably affected most settings and relations. In addition, healthcare personnel struggled to conduct triage in accordance with prioritisation criteria to ensure fair and just allocation of healthcare ( Jøranson et al, 2022 ; NOU2021:6 ).…”

“…We conducted a qualitative sub-study to explore and describe older patients' experiences with having COVID-19 before, during, and after hospital admission, from which this single case is taken. The substudy has been described previously (Heiberg et al, 2022a(Heiberg et al, , 2022bJøranson et al, 2022).…”

“…Infected patients had contracted an unknown and experienced a frightening disease with unfamiliar and severe symptoms. Uncertainty regarding outcomes of COVID-19 was a troubling backdrop to their search for medical help ( Jøranson et al, 2022 ).…”

Older people's experiences of vulnerability in a trust‐based welfare society affected by the COVID‐19 pandemic

“…Nevertheless, compared with many other countries, Norway had relatively few hospitalised patients and deaths due to COVID-19 (Christensen & Laegreid, 2020;Kvinnsland et al, 2021), which is related to its strong national institutions, sound economic situation and high-trust society (Jøranson et al, 2022).…”