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Nurses have described the ordeal of working amid the coronavirus outbreak.
The charity Marie Curie asked nearly 900 nurses whether the pandemic has affected how they carry out of end of life care.
Almost half (45%) of the participants claimed they have been more involved in palliative support since the outbreak emerged.
With hospitals and care homes restricting visitor numbers to help stem the pandemic, many patients have died without loved ones present, leaving nurses to “absorb the emotions”.
While personal protective equipment (PPE) is vital to keeping staff safe, one noted “a dying person’s last contact with another person is through a gloved hand, a smile that can’t be seen because of the mask”.
Marie Curie and the professional magazine Nursing Standard carry out a survey every year to uncover the challenges facing staff.
Focusing on the coronavirus, the survey was sent out in September across the UK to a range of nurses and care home workers, from midwives to healthcare assistants.
Seven in 10 (70%) of the 893 participants claimed it is more difficult to have a compassionate conversation with a patient’s loved ones during the pandemic.
Many nurses have also had to break distressing developments over the phone.
“I put the phone down and cried my heart out,” said one of the participants, who were all anonymous.
“To give someone bad news over the phone, not knowing where they are and who they are with, not holding their hand or sitting down with them, [was] horrible.”
Not having a patient’s loved ones present has also left many nurses feeling under greater pressure to deliver the best possible care.
“Not having the relatives with the patients during the time of death felt like a huge responsibility on nursing staff to get it absolutely right,” one said.
Another added: “During COVID, it felt like the nursing staff absorbed the emotions when our patients died.”
Strict rules on visitor numbers has also forced patients to make tough decisions.
“We had one palliative care resident at the end of life due to a brain tumour who refused to have her family visit because she would not choose which one of her four children it should be,” said one of the nurses.
Watch: Can you catch the coronavirus twice?
A third (33%) of the participants claimed PPE, while necessary, is the main barrier to delivering good patient care.
Nearly two in five (38%) also worry the nursing profession as a whole does not have the capacity to provide high-quality end of life support amid the UK’s ongoing second wave.
As the pandemic continues to unfold, some also claimed their mental health has been affected.
“We are all tired mentally and physically,” said one of the nurses. “We do what we do because we want to help, but I can see it is affecting my own health.”
Another added: “I have many colleagues experiencing PTSD [post-traumatic stress disorder] symptoms relating to patient deaths in the department.
“Many have had to take time off sick or are planning to leave the profession.”
Julie Pearce from Marie Curie – who has worked on an intensive care unit amid the pandemic, said: “I experienced a glimpse of what it was like for these inspirational nurses and I too experienced what it was like to wear full PPE for hours at a time.
“The survey also shows the level of fear and anxiety felt amongst patients and their families which was absorbed by nurses, trying to do the best they could to be reassuring, kind and compassionate.
“Under these circumstances the mental health and wellbeing of staff is in jeopardy.”
While face to face visits may be on hold, Pearce added keeping loved ones informed of a patient’s health remains important.
“While compassionate conversations about dying, death and bereavement have been difficult for nurses and caring services during the pandemic, conversations about what matters most to people is central to the person’s experience at the end of life,” she said.
“For Marie Curie nurses, we found advance planning with patients and their families was possible by video conference and by telephone. It isn’t ideal but it is possible.”
Flavia Munn, editor of Nursing Standard, added: “From the nurse who was in floods of tears after breaking bad news by phone, to their colleagues whose gloved hands were the last contact for dying patients, COVID-19 is having a significant personal impact on nursing staff who are looking after end of life patients.
“The death of a patient is never easy but PPE and visiting restrictions are leaving nurses distressed that they are unable to provide the kind of care they ordinarily would in a patient’s final days.
“Nurses’ wellbeing needs care too.”
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