Article
“...but at the end of the day, it's humanness that matters.” – An exploratory qualitative study on causes of stress in palliative care nursing during the COVID-19 pandemic
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Authors
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Susann May
- Medizinische Hochschule Brandenburg – Theodor Fontane, Zentrum für Versorgungsforschung, Neuruppin, Deutschland
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Kerstin Stahlhut
- Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Deutschland
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Matthew Allsop
- Leeds Institute of Health Sciences, United Kingdom
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Martin Heinze
- Medizinische Hochschule Brandenburg - Theodor Fontane, Zentrum für Versorgungsforschung, Neuruppin, Deutschland
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Felix Mühlensiepen
- Medizinische Hochschule Brandenburg – Theodor Fontane, Zentrum für Versorgungsforschung, Neuruppin, Deutschland
| Published: | September 27, 2021 |
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Outline
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Background: Healthcare professionals during the COVID-19 pandemic are providing care under challenging circumstances with nurses experiencing higher subjective stress than other professional groups. In delivering palliative care, nurses serve the psychosocial needs of patients and relatives in desperate life situations and are often the key contact in formal end-of-life care. It is essential to understand nurses' experiences during COVID-19 to guide efforts to ameliorate, where possible, causes of additional burden arising from the pandemic, alongside guiding future pandemic responses.
Objective: To explore and analyse causes of stress among nurses in palliative and hospice care settings in Germany during COVID-19 pandemic.
Methods: This is an exploratory, qualitative interview study in different settings of palliative and hospice care. Problem-centered interviews were conducted with 16 nurses from hospice, out- and in-patient palliative care settings based on a participatory designed interview guide. Interview data was analysed using structured qualitative content analysis.
Results: COVID-19 infection control measures placed both physical and psychological strain on palliative care nurses. Due to changes in infection control information, workflows were being readjusted on a daily basis, preventing everyday routines and hindering relief from stress. There are no opportunities for sharing and reflecting upon daily working routines with team colleagues. Specific causes of stress in the individual settings of palliative and hospice care were identified. Overall there is a tension between the nurses’ perceptions of proper palliative care nursing, in terms of closeness, psychosocial and emotional support, and compliance with infection control measures. This causes individual stress among nurses and also puts them at risk of infection.
Discussion: Palliative care nurses have been exposed to high levels of physical and psychological stress across outpatient, inpatient, and hospice settings during COVID-19. These causes of stress are both transverse and setting-specific. There is a tension between nurses’ own professional and compliance with infection control measures. This requires rapid relief and support, with a need to ensure continuity of professional supervision and peer-support, which can be facilitated via digital technologies.
Practical implications: Developing approaches to identify and address stressors in their delivery of care during the pandemic should be explored to support their role in the palliative care workforce.
Appeal for practice (science and/or care): The unique role of nurses in hospice and palliative care during COVID-19 ought to be recognized and valorised.
