ABSTRACT
Background: Hospitals are the most frequent place of death in Germany (47%), but at the same time, the least preferred one - for both patients and their relatives. To optimize care in the dying phase by using a bottom-up approach, the StiK-OV project aims to implement and evaluate specific measures on different non-palliative wards at two university hospitals. In the first phase of the project, we assess the current state of care in the dying phase on different wards. Method(s): We conducted an online survey with national health care professionals consisting of seven open questions on important aspects, facilitators, barriers and needs for improvement as well as Covid-19 pandemic specifics regarding care in the dying phase. Qualitative data was analyzed thematically. Result(s): Of 67 participants, 66% work in clinical practice as nursing staff (52%) and physicians (30%) and 34% in management or administration. As relevant topics of care in the dying phase, we identified involvement of relatives, symptom control, patient-centeredness, professional competencies, as well as time, space and human resources. Participants state a need for improvement regarding these topics. During the pandemic, involvement of relatives and patient-centeredness were difficult to maintain due to visiting restrictions and higher workload, resulting in patient isolation and dying in loneliness. Discussion(s): The survey revealed common topics of importance which should be targeted by ward-specific measures. Difficulties due to the pandemic have to be accounted for to achieve optimal care in the dying phase under exceptional circumstances. Conclusion(s): The survey gave insights on care in the dying phase from the perspective of health care professionals that can help to develop and implement situation-specific measures to significantly improve the quality of care during the dying phase in hospitals. A bottom-up approach aims to increase the staff motivation to implement respective measures.
ABSTRACT
Background/aims: Hospitals are the most frequent place of death in Germany (47%) but also the least preferred one - for both patients and relatives. The project 'StiK-OV' aims to optimize care for dying patients in hospitals using a bottom-up approach. Therefore specific measures on non-palliative wards at two university hospitals will be implemented and evaluated. In the first project phase, the current state of non-specialist inpatient care in the dying phase was assessed. Methods: Online survey with national health care professionals in the field of care in the dying phase. The survey consisted of seven open-ended questions on important issues, facilitators, barriers and needs for improvement regarding the care for patients dying in hospitals as well as COVID-19 pandemic specifics. Qualitative data was analyzed thematically. Results: Of 67 participants, 66% worked in clinical practice, 34% in managerial positions. We identified five relevant topics of care in the dying phase: involvement of relatives;symptom control;patient-centeredness;professional competencies;as well as time, space and human resources. Participants aimed to uphold patient-centeredness as a priority in the dying phase despite reporting needs for improvement in all topics: 'Everything that is good for the patient is allowed.' This contrasts with the experience during the pandemic, when involvement of relatives and patient-centerednesswere hard to maintain due to visiting restrictions and high workload - leading to patient isolation and dying in loneliness. Conclusions: The survey revealed common topics on care in the dying phase from the perspective of health professionals to be targeted by ward-specific measures. Difficulties due to the pandemic have to be considered for optimal care in the dying phase under exceptional circumstances. The results can help to develop and implement context-specific measures to improve quality of hospital care during the dying phase.
ABSTRACT
Background: In order to be able to ensure the quality of someone's life until the end, social participation and dignity are important aspects, as well as the public perception of preserving personality and identity. However, the COVID-19 pandemic caused strict visiting regulations in hospitals and nursing homes and therefore physical segregation of dying people. Aims: To explore the people's perceipton of death-related issues before and during the pandemic. Methods: After the first COVID-19 lockdown in Germany we conducted an online survey with citizens who were interested into participating in the Caring Community Cologne project. Respondents were asked to describe their views on dealing with death, mourning and dying before and during the pandemic. Free-text comments were analyzed using qualitative content analysis. Results: 68 participants completed the survey. The majority of respondents were 50 to 70 years old (64 %) and female (65 %). Most of them worked in the social sector (43 %). The most frequently mentioned aspects were: •Non-professional care structures need to be strengthened, existing structures should be made visible and connected with each other. The end of life was brought into public view. •The fear of social isolation for older and sick people and the inadequate support for the dying and their relatives lead to concerns. •There is growing concern about a lack of human togetherness. •The importance of caring for one another within an informal context increases. •There is a greater need for the discussion of death-related topics. Conclusion/discussion: The drastic changes during the pandemic seem to affect the views on institutionalized care as well as the perception and experience of social cohesion. In addition, individual needs on a local and interpersonal level as well as the confidence in and extent of their concerns about cohesion become apparent.
ABSTRACT
Background: For infection control reasons, dying patients in care facilities were isolated from their relatives due to visit restrictions, regardless of COVID-19 diagnosis. Aim: To explore bereaved relatives' experiences with visit restrictions of dying patients during the COVID-19 pandemic. Methods: Post-bereavement online survey plus additional semi-structured in-depth interviews to assess relatives' experiences with patients who died between 3.-11.2020 in different care settings, with/without COVID-19. Quantitative data were analysed descriptively including subgroup analysis and qualitative data by content analysis. The presented results focus on relatives' experiences with visit restrictions and are part of the PallPan project which develops a 'National Strategy for Palliative Care during a Pandemic'. PallPan is a project of the National Network University Medicine (NUM) to manage and overcome the pandemic. Results: 81 relatives responded to the online survey, 87.5% felt burdened by the pandemic-associated circumstances, 9.6% reported that even after the end of the official visitor ban, visits were not allowed in all facilities and the majority of relatives (65.4%) still felt burdened. Interviews with 32 relatives revealed the importance of visits respectively the burden relatives suffered when visits were prohibited. This caused difficulties in communication with the healthcare team about the patient's condition/treatment and reduced the possibility of (physical) closeness with the dying. Case-by-case decisions to allow companionship and farewell were valued by the bereaved. Conclusion: Visit restriction at the patient's end of life caused a great burden on relatives even months after the patient's death. Concepts to enable visits during the last days of life are needed including flexible pathways to ensure shared time and close companionship of patients and relatives.