Over two thirds (70%)1 of nurses felt it was harder to have compassionate conversations with patient’s families during the pandemic an exclusive survey has revealed, with over a third (38%)2 saying they did not think there is enough capacity to provide high quality end of life care in the event of a second wave.
The annual survey, carried out by Nursing Standard and end of life charity Marie Curie, was answered by nearly 1000 (893) nurses and other caring staff who revealed the impact coronavirus has had on nurses delivering end of life care across the UK. Almost half (45%)3 of nurses said they have been more involved in delivering end of life care during the pandemic.
Nurses spoke about the emotional impact of sitting with dying patients in the absence of family members and loved ones. “Not having the relatives with the patients during the time of death felt like a huge responsibility on nursing staff to get it absolutely right” another said: “During COVID it felt like the nursing staff absorbed the emotions when our patients died.”
Many respondents expanded on the difficulties of communicating with patients’ families virtually and by the phone. One nurse said: “I put the phone down and cried my heart out. To give someone bad news over the phone, not knowing where they are and who they are with, not holding their hand or sitting down with them, [was] horrible.” Nurses also said that visiting restrictions left families feeling “bereft of involvement”.
“We had one palliative care resident at the end of life due to a brain tumour who refused to have her family visit because she would not choose which one of her four children it should be”, one nurse commented.
As the nation approaches a second wave, some nurses said that they would step up to the challenge while others feel they are still absorbing the first wave.
“We are all tired mentally & physically. We do what we do because we want to help but I can see that it is affecting my own health” said one nurse. Another says: “I have many colleagues experiencing PTSD symptoms relating to patient deaths in the department. Many have had to take time off sick or are planning to leave the profession.”
A third of nurses (33%)4 said PPE (personal protective equipment) was the main barrier to providing good end of life care. “A dying person’s last contact with another person is through a gloved hand, a smile that can’t be seen because of the mask” another nurse added.
Julie Pearce, Marie Curie chief nurse and executive director of caring services, returned to the NHS at the weekends working in her local hospital’s intensive care unit supporting COVID-19 patients. She said: “I experienced a glimpse of what it was like for these inspirational nurses, and I too experienced what it was like to wear full PPE for hours at a time. The survey also shows the level of fear and anxiety felt amongst patients and their families which was absorbed by nurses, trying to do the best they could to be reassuring, kind and compassionate. Under these circumstances the mental health and wellbeing of staff is in jeopardy, especially as we head towards a second wave.
“While compassionate conversations about dying, death and bereavement have been difficult for nurses and caring services during the pandemic, conversations about what matters most to people is central to the person’s experience at the end of life. For Marie Curie Nurses we found that advance planning with patients and their families was possible by video conference and by telephone. It isn’t ideal but it is possible.”
Nursing Standard editor Flavia Munn said: “From the nurse who was in floods of tears after breaking bad news by phone to their colleagues whose gloved hands were the last contact for dying patients, COVID-19 is having a significant personal impact on nursing staff who are looking after end of life patients.
“The death of a patient is never easy but PPE and visiting restrictions are leaving nurses distressed that they are unable to provide the kind of care they ordinarily would in a patient’s final days. Our survey findings further highlight why mental health support is so vital for nurses right now, whether that’s dedicated counselling lines, structured debriefing sessions or a post-shift chat with a colleague. Nurses’ wellbeing needs care too.”
The full results of the survey are available here: rcni.com/marie-curie-2020