gms | German Medical Science

Background: As a result of the COVID-19 pandemic, nursing, palliative and hospice care facilities are facing different challenges. Amongst others, they result from the advanced age and pre-existing diseases of those in need of care, which are risk factors for a severe course of COVID-19. In addition, necessary protective measures such as visitation restrictions can create legal, social and ethical dilemmas between infection control and the protection of vulnerable individuals on the one hand, and ensuring basic patient rights on the other hand.

Question and objective: The aim of this study was to develop a handbook to support nursing, palliative and hospice facilities in dealing with pandemic-related challenges.

Methods: The study used a mixed-methods design that included a scoping review of existing recommendations for nursing, palliative and hospice facilities (n=51), a document analysis of 138 facility websites, ten qualitative telephone interviews with family members of patients receiving palliative care, a nationwide online survey of nursing, palliative and hospice facilities (n=10,718) and interviews with seven staff members of selected facilities. Data from each research approach were triangulated and synthesized into a handbook. The handbook was discussed and consented in two discussion circles with relatives and experts.

Results: The handbook contains recommendations for addressing pandemic-related challenges in nursing, palliative and hospice care and is divided into two parts. The first part presents measures for preparation and organization, hygiene and infection control, human resources management, procurement of and equipment with protective materials, interaction with external institutions, and psychosocial support for those in need of care and their relatives, as well as for healthcare workers. In the second part, selected aspects such as needs of patients, visitor policies, staff wellbeing and vaccination are examined from an ethics perspective applying the principles of Beauchamp and Childress [1].

Discussion: The handbook developed can help address pandemic-related challenges and provide support. It consists of concrete recommendations for action and information on how to deal with potential problem situations. In the form of hands-on advice, the handbook can thus promote organization and patient-orientation in care.

Practical implications: The handbook can support facilities in addressing the current as well as future pandemics and other public health crises, by providing evidence-based, hands-on recommendations. For this, the handbook must be made available to facilities and their staff and should be further evaluated with respect to its usability in future research.

Appeal to practice (science and/or care) in one sentence: The handbook can promote the implementation of crisis-sensitive care in facilities - but in doing so, facilities must also be supported by care providers and other stakeholders in order to overcome existing implementation barriers.

Funding: Einzelförderung (BMG, DRV, BMBF, DFG, etc); 01KI20126