Being a Hospice Nurse in Times of the COVID-19 Pandemic: A Phenomenological Study of Providing End-of-Life Care.

End-of-life care changed during the COVID-19 pandemic, and the previous prevailing hospice philosophy and essential values of hospice care were suddenly under pressure. The aim was to explore hospice nurses' lived experience of providing end-of-life care to patients admitted in an out-hospital hospice setting during the COVID-19 pandemic. Data consist of 10 individual in-depth interviews of hospice nurses. A purposive sampling strategy was used, and the data collection and analysis was guided by a descriptive phenomenology. Providing end-of-life care was described through an existential dimension and a practical-related dimension. The pandemic and the ensuing constraints created an unfamiliar gap, triggering insecurity and unfamiliarity within nursing. Findings are elaborated in the following constituents: being a hospice nurse and providing end-of-life care. The latter constituent was further elucidated in additional perspectives: a new job position and bending the rules. Providing end-of-life care during the COVID-19 regime was a highly challenging and distressing experience due to the coercion of maintaining rules and restrictions as well as providing care. An experience of having to reinvent and work within a new agenda was present. Furthermore, the nurses experienced significant loss of job satisfaction and may be morally injured as well as highly exposed to secondary traumatization.

Living with the risk of being infected: COPD patients' experiences during the coronavirus pandemic.

AIMS: To explore the existential significance of living with the risk of being infected with coronavirus in patients with COPD. BACKGROUND: Distancing measures aim to break the coronavirus transmission chains. Physical separation from social networks and social isolation are correlated with anxiety and depression. People with a chronic obstructive lung disease are particularly vulnerable due to the increased risk of a serious course of illness, so therefore many of them choose self-isolation to protect themselves from COVID-19. DESIGN: A qualitative exploratory study using individual semi-structured interviews. METHODS: From June-September 2020, 13 participants were recruited through advertisements on Facebook as a convenience sample for semi-structured individual interviews. The interviews took place through virtual platforms or in physical meetings. Data were analysed using Ricoeur's phenomenological approach, involving naïve reading, a structural analysis and a critical interpretation strategy. The study has been reported in line with COREQ guidelines. FINDINGS: Living with the threat of being infected with coronavirus has greatly affected everyday life for patients with COPD. The nagging fear of coronavirus as a death threat was a dominant feeling, together with anxiety, loneliness and hope. With self-isolation, followed concerns of being forgotten and thoughts of the future, balancing between fearing the worst, and hoping the best. CONCLUSIONS: Patients with moderate to severe COPD feel compelled to self-isolate, as they fear dying from COVID-19. The study revealed a need for proactive contact with health professionals to calm the patients' feelings of deprivation, loneliness, hopelessness and anxiety. RELEVANCE TO CLINICAL PRACTICE: Information about the patient's perspective may be used to develop targeted interventions aimed at giving adequate information, supporting hope, implementing digital or virtual solutions to keep in contact and avoid the feeling of being alone and forgotten during a pandemic crisis.