ABSTRACT
Aims: The COVID-19 pandemic forced a trade-off between the interests of all versus those of individuals. Therefore, many healthcare organisations applied visiting restrictions, also for dying patients.Our aim was to explore, in an international context, if visiting restrictions for dying patients had an impact on the quality of life of healthcare professionals. Method(s): From April 2020 to June 2021, an open online survey was conducted among healthcare professionals in 14 countries;Belgium, Czech Republic, Norway, Slovenia, the Netherlands, United Kingdom, Argentina, Brazil, Chile, Colombia, El Salvador, Uruguay, Indonesia and Japan. The survey consisted of validated and purposively designed measures of perceived quality of care (CODE) and staff QoL. Data were analysed descriptively and inferentially, with regression analysis conducted for all countries, and the results pooled and analysed in a multilevel analysis using Cochrane Review Manager. Result(s): Among 2925 respondents (mean age 42 years), 2385 (81.8%) were female, 1601 (54.9%) were nursing staff, and 1560 (53.3%) worked in hospitals. Approximately half of the patients reported on were men (n = 1470, 50.4%) and 1202 (41.4%) were COVID-19 positive. In all countries, the majority of respondents rated medical and nursing care for the patient as sufficient (n = 2468, 84.6%, and n = 2426, 83.2%, respectively). In 1559 cases (53.9%), visitors were allowed with limitations during the last 2 days of the patient's life, and in 468 cases (16.2%) no visits were allowed at all. Most respondents rated their QoL during the past week as 4 or higher out of 7. Mean QoL was lowest in Brazil (M 3.94, SD 1.34) and highest in Indonesia (M 5.80, SD 1.21). Regression analyses showed that no or limited visiting in the last days of life, was associated with lower QoL scores of healthcare professionals compared with those who reported that visiting was unrestricted (OR 0.63, 95%CI 0.48-0.83, p<0.001). Heterogeneity between countries was high. Conclusion(s): Our results suggest that visiting restrictions are associated with QoL of healthcare professionals. It may be that restrictions resulted in staff feeling unable to provide the desired level of care, and in turn affected their role perception and QoL.
ABSTRACT
Background: Even though Norway has had few deaths from Covid-19, infection control measures have affected most areas of life. Aims: To investigate how care for the dying was experienced during the first wave of the pandemic. Methods: Online survey of bereaved relatives using questionnaire based on Care of the Dying Evaluation (CODE) with option for free text comments, accessible July-Oct 2020. Open invitation via websites and newspapers. Analysis by SPSS and thematic analysis. Results: 102 participants completed the questionnaire, median age group 50-59, 83% women, 61% had lost a parent. The deceased were 46% female, 76% >70 years, 48% had cancer, 24% dementia, 5% Covid- 19;83% died March-June. Place of death: 16% home, 34% hospital, 41% nursing home, 8% palliative care units. 71% had restrictions on visiting. While 86% of the relatives perceived medical and nursing care for the patients as good, 35% perceived themselves not adequately supported in the patient's final days. Free text comments included the following themes: reduced access to staff, reduced quality of care, missing or conflicting information, limitations caused by personal protection equipment, restrictions on visiting, lack of contact from staff during bereavement, but also acknowledgement of staff doing their best under extreme circumstances. 'Restrictions on visiting' could be divided into: consequences for the patients, conflicts with staff, limited possibilities for online contact, relatives' solitude, deprived possibilities for caregiving and follow-up, visiting only on the last two days implying lost possibilities for addressing personal matters and saying good-bye. Conclusion: Patients as well as relatives were deeply affected by the infection control measures and restrictions on visiting. The most striking finding was that visiting in the last two days could not make up for the lack of visits in the weeks before. Also, follow-up of bereaved relatives is important and often neglected.