Visitor Restrictions, Palliative Care, and Epistemic Agency: A Qualitative Study of Nurses’ Relational Practice During the Coronavirus Pandemic

Abstract

Efforts to curb spread of COVID-19 has led to restrictive visitor policies in healthcare, which disrupt social connection between patients and their families at end of life. We interviewed 17 Canadian nurses providing palliative care, to solicit their descriptions of, and responses to, ethical issues experienced as a result of COVID-19 related circumstances. Our analysis was inductive and scaffolded on notions of nurses’ moral agency, palliative care values, and our clinical practice in end-of-life care. Our findings reveal that while participants appreciated the need for pandemic measures, they found blanket policies separating patients and families to be antithetical to their philosophy of palliative care. In navigating this tension, nurses drew on the foundational values of their practice, engaging in ethical reasoning and action to integrate safety and humanity into their work. These findings underscore the epistemic agency of nurses and highlight the limits of a purely biomedical logic for guiding the nursing ethics of the pandemic response.

Ethical dilemmas experienced by nurses while caring for patients during the COVID‐19 pandemic: An integrative review of qualitative studies

“…Studies were conducted in Iran ( n = 4), China ( n = 2), Turkey ( n = 2), the United States ( n = 2), Canada ( n = 1), Jordan ( n = 1), Korea ( n = 1) and Sweden ( n = 1). In nine studies, the majority of participants were female; in two studies, all participants were female (Kwon & Choi, 2021 ; McMillan et al, 2021 ); in two studies, gender was not mentioned (Kelley et al, 2021 ; Silverman et al, 2021 ); and in one study, the majority of participants (60%) were male (Alloubani et al, 2021 ).…”

“…A total of seven articles had the main objective related to topics on nurses' ethics during the COVID‐19 pandemic (Abbasinia et al, 2021 ; Alloubani et al, 2021 ; Jia et al, 2021 ; Karaca & Aydin Ozkan, 2021 ; Liu et al, 2021 ; McMillan et al, 2021 ; Rezaee et al, 2020 ; Stenlund & Strandberg, 2021 ), four articles (Kelley et al, 2021 ; Kwon & Choi, 2021 ; Moghaddam‐Tabrizi & Sodeify, 2021 ; Muz & Erdogan Yuce, 2021 ) had nurses' experiences in care of patients with COVID‐19 as main objective, one article (Silverman et al, 2021 ) was about moral distress in nurses caring for patients with COVID‐19, and the remaining article (Mohammadi et al, 2021 ) was conducted with nurses who were infected with COVID‐19. The participants' perceptions of ethical dilemmas are presented in the results of all 14 articles.…”

“…Not being able to provide holistic patient care was another fact pointed out by nurses as a trigger for ethical dilemmas. Difficulties in providing psychological (Jia et al, 2021 ; Muz & Erdogan Yuce, 2021 ), physical (Jia et al, 2021 ; Karaca & Aydin Ozkan, 2021 ; Liu et al, 2021 ; Muz & Erdogan Yuce, 2021 ) and social care (Jia et al, 2021 ;Kwon & Choi, 2021 ; McMillan et al, 2021 ) and lack of spiritual care (Rezaee et al, 2020 ), comfort care (Kelley et al, 2021 ; Silverman et al, 2021 ), end of life care (Kelley et al, 2021 ; McMillan et al, 2021 ) and family‐centred care (Rezaee et al, 2020 ) were identified by nurses during the COVID‐19 pandemic. These dilemmas emerged because nurses had a lack of knowledge and skills to work in COVID‐19 wards (Jia et al, 2021 ; Karaca & Aydin Ozkan, 2021 ; Kelley et al, 2021 ; Liu et al, 2021 ); thus, they feared that they were not doing their job correctly (Jia et al, 2021 ; Kelley et al, 2021 ; Muz & Erdogan Yuce, 2021 ; Silverman et al, 2021 ) and that they were harming the patient due to inexperience or lack of necessary training (Karaca & Aydin Ozkan, 2021 ).…”

“…Nurses pointed out that family visits are not only important to provide emotional support but also to give information about patients (Stenlund & Strandberg, 2021 ). Especially in palliative care services, visitor restrictions were pointed out as a huge ethical dilemma for nurses, because contact with family is considered a palliative intervention (Kwon & Choi, 2021 ; McMillan et al, 2021 ). Nurses also emphasized the lack of support for families after the patient's discharge or death (Rezaee et al, 2020 ).…”

Converting threats from COVID-19 in long term care into opportunities for improvement

“…In a qualitative study, McMillan, et al, report nurses found the policies which separate people from families to be incongruent with nursing values and ethics. [27] Nurses are integral to an interdisciplinary team with social workers, recreation therapists, community liaisons, and administrators to connect residents with family or support persons using technology or by developing and implementing policies which meet both biomedical and humanistic needs.…”