The ad hoc establishment of an acute palliative care (PC) ward for COVID-19 patients in a tertiary university hospital in Germany-the perspective of the staff and stakeholders involved

ABSTRACT

Background: Due to the steep increase of Covid-19 cases in March 2020, we established a PC ward for dying Covid-19 patients to support emergency/ intensive care medicine in the event of capacity shortages and to create a dignified PC. The station was up and running within 3 days, with both PC team members and volunteer nurses from non-palliative care units working together. Aims: To explore How did staff and stakeholders experience the ward's ad hoc implementation? What are the lessons learned? Methods: A qualitative study was conducted (May-November 2020). 29 semi-structured interviews were led with PC staff, voluntarily enlisted staff and management, transcribed verbatim and a qualitative content analysis was performed. Results: Patient care and team collaboration were rated positively. Whereas the volunteers had the role of open-minded learners, the PC staff was considered as experts in end-of-life care and approachable instructors. The joint induction training proved to be central. This included a kick-off meeting and equipment training, the familiarization with the ward, training at the patient's bedside by the PC team as well as the support of the nursing/medical management. Named challenges were yet On the volunteer side an adaption to PC routines and a different culture of care;balancing the high standards of PC against the backdrop of pandemic conditions on the PC team side. Also, criticism was levelled at the rapid opening of the ward as sufficient capacities at the other Covid-19 stations led to a low occupancy of the ward, staff overcrowding and frustration. Conclusion: Our study shows the possibility to establish an ad hoc acute PC unit, where PC staff in a short time can successfully train volunteers. Nevertheless, due to the unpredictable dynamics of a pandemic, management and staff should be prepared for both scenarios a low as well as a high occupancy of the station and the burden that comes along with each challenge.