Palliative care nursing during the height of the COVID-19 pandemic: experience from a Victorian health service
An article written by Associate Professor Jaclyn Yoong
It doesn’t need to be said that the COVID-19 pandemic was a difficult time for all healthcare workers, no matter what discipline or category of workers. The COVID-19 pandemic which was officially named by the World Health Organisation in 2020 was unprecedented and no one was prepared for its far-reaching and devastating consequences. Multiple studies which have since been published in scholarly journals, as well as mainstream media, are unanimous in their recognition of how frontline healthcare workers have been affected by the pandemic.
In our study ‘Palliative care nursing during the COVID-19 pandemic: reflections from Melbourne, Australia’, we chose to survey specifically a cohort of palliative care nurses in Victoria, Australia. Victorians will recall that throughout the pandemic Victorians experienced several peaks and waves, and were subject to prolonged and severe lockdowns. Illness, death, and dying in hospitals impacted palliative care nursing staff like never before. This was not a one-dimensional experience and indeed affected the staff in many ways. We conducted this survey at a tertiary Melbourne hospital that services a busy corridor and had a central role in the COVID-19 response for the population.
Not surprisingly the palliative care nurses surveyed reported primarily negative emotions: stress, anxiety, frustration and sadness. This was partly a direct consequence of COVID-19 itself: the manifestation of the illness and the numbers dying from it; also the personal impact of potential infection of self and/or loved ones. There were the challenges of providing adequate nursing with full personal protective equipment (PPE) and the challenges of managing the specific symptomatology associated with COVID-19 (e.g. breathlessness, agitation, restlessness). There were also concerns about the health system becoming overwhelmed – due to staffing issues, burnout, and lack of resources – in this uncharted territory.
Lockdowns and visitor restrictions at hospitals, including the palliative care units, also impacted the experience of palliative care nursing. The patient-family (or carer) dyad cannot be underestimated during the time of illness, dying, and great emotional stress. Due to visitor restrictions patients were deprived of this interaction and the social isolation was witnessed first-hand by the nursing staff. One nurse wrote that patients dying alone “is contrary to everything I believe about the quality of death.” Many endeavoured to fill this void by attempting creative means of connecting patients and their families: through electronic devices, faces through windows. Many nurses sought to be the family that could not be physically present for their loved ones.
In addition to reporting at face value how the pandemic affected them, some also reflected that their core business of palliative care did not change, just the way they went about it had to be revised (significantly). Others reflected that there were lessons to be learnt from coping with the adversity, for example how technology might be incorporated into the delivery of healthcare and that there is ongoing benefit from novel relationships with other services forged in the pandemic. Several nurses expressed hope for society as a whole to move forward with greater clarity about what is important and how to work together in a local and global community.
Palliative care nurses played a critical role in the care of patients with advanced illness, whether directly related to COVID-19 or not in the past 3 years, with great resilience in challenging times. At the time of writing the pandemic is not officially over, but with high rates of vaccination in many parts of the world, and in Victoria, the clinical manifestation of the virus is evolving. While there are still challenges presented by COVID-19, healthcare workers are more informed and better prepared from the knowledge and experience gained over recent times.
Useful links
Yoong J, Park ER, Greer JA, Jackson VA, Gallagher ER, Pirl WF, Back AL, Temel JS. Early palliative care in advanced lung cancer: a qualitative study. JAMA Intern Med. 2013 Feb 25;173(4):283-90. doi: 10.1001/jamainternmed.2013.1874.
Chosich B, Burgess M, Earnest A, Franco M, Runacres F, William L, Poon P, Yoong J. Cancer patients' perceptions of palliative care. Support Care Cancer. 2020 Mar;28(3):1207-1214. doi: 10.1007/s00520-019-04917-8. Epub 2019 Jun 19.
Associate Professor Jaclyn Yoong
Palliative Care Physician & Medical Oncologist
Northern Health
Monash Health