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Coping with COVID-19 deaths: what we need in the next phase

How we can plan now to reduce strain on nursing staff, and on grieving families

Marie Curies chief nurse on how the plans we make now can help reduce strain on healthcare staff, and on grieving families

Picture: Barney Newman

The findings of our annual Nursing StandardMarie Curie survey show that COVID-19 has brought huge challenges for nursing staff delivering end of life care.

Wearing personal protective equipment (PPE), although essential, is draining and has created a physical barrier to communication. And we have been left emotionally exhausted, absorbing the fears and anxieties of our patients and their families while working to treat, to reassure and to show kindness and compassion.

Grieving under abnormal circumstances

Under normal circumstances, health professionals are equipped to respond to peoples feelings of grief and loss. But the volume of deaths during the pandemic

Marie Curie’s chief nurse on how the plans we make now can help reduce strain on healthcare staff, and on grieving families

A nurse in PPE washing the arms of a patient in a hospital bed
Picture: Barney Newman

The findings of our annual Nursing Standard–Marie Curie survey show that COVID-19 has brought huge challenges for nursing staff delivering end of life care.

Wearing personal protective equipment (PPE), although essential, is draining and has created a physical barrier to communication. And we have been left emotionally exhausted, absorbing the fears and anxieties of our patients and their families while working to treat, to reassure and to show kindness and compassion.

Grieving under abnormal circumstances

Under normal circumstances, health professionals are equipped to respond to people’s feelings of grief and loss. But the volume of deaths during the pandemic has meant we have not had enough time to process the enormity of recent months, jeopardising our own health and well-being.

This pandemic will leave a long-lasting legacy for the whole population, not least the families unable to be with loved ones in their final moments.

For many, the grief began before their loved one died, as they were unable to see them in person, due to visiting restrictions in homes and hospitals.

End of life care and the lessons of the first wave: what nurses told our survey

What matters to patients and their families

In response to increasing numbers of people seeking and needing help with their grief as a result of the pandemic, Marie Curie launched a bereavement support line available to the public and health and social care professionals.

As an end of life care charity, Marie Curie has been having compassionate conversations with patients and their families about end of life care and what matters to them.

More people wanted to be cared for and to die at home, with their families, pets and familial things around them. They didn’t want to be disconnected by the restrictions on visiting.

A nurse in PPE in the hallway of a patient's home
Nurses have been doing what they can to enable patients to die at home if that is their wish
Picture: Alamy

Nursing teams worked together to try and make this happen: district nursing teams working with nursing teams from charities and the voluntary sector, as well as staff from care agencies, to organise rapid discharge from hospital or allow people to remain at home.

‘Pooling resources and avoiding duplication will mean that we can care for many more people at home – this should be one positive outcome of the pandemic’

We worked together, offering mutual support face to face and virtually, and being energised by making things happen through cross-organisational working.

Working closely together is a good thing and we must take the opportunity to build on this.

Pooling resources and avoiding duplication will mean that we can care for many more people at home – this should be one positive outcome of the pandemic.

We need to be kind to ourselves and set aside time to reflect and re-energise, even amid the busyness of family and work life. We owe it to ourselves, our families and the people we care for.

‘My shifts offered a glimpse of what it was like for ICU nurses’

During the first wave of the pandemic I continued in my role as Marie Curie chief nurse and executive director of quality and caring services, supporting our nurses and healthcare assistants across the UK.

I also returned to the NHS, working weekends in the intensive care unit (ICU) at my local hospital. I wanted to contribute and remain connected to patient care.

I learned so much from those I worked alongside: their personal experiences, challenges, frustrations, fears, loss and sense of not being able to provide care in the way they normally would.

During meal breaks, they spoke about the difficulties of feeling disconnected from their families, with many younger staff finding it hard not being able to meet with family and friends.

My shifts offered a glimpse of what it was like for these inspirational ICU nurses. I experienced what it was like to wear full PPE for hours at a time, doing my best to undertake all aspects of ICU nursing, as well as facilitating the challenges of virtual visiting and witnessing the fear and anxiety of family members.

The COVID-19 patients I won’t forget

During my time in the ICU, two patients stood out.

One was a young man, about the same age as my son. In addition to COVID-19, he had an underlying condition of alcoholic liver disease and sadly died.

Before arriving in ICU, he had made it clear he did not want any contact with his mother or any information about his condition to be shared. His mother phoned each day, and of course staff were obliged to respect his wishes. The anguish experienced by his mother was palpable. When he died, I felt so sad that we had no way of knowing him better as a person.

Another was a man, only a few years older than me, who nearly died several times. Through the meticulous treatment protocols and care delivered over many weeks by the multidisciplinary team, he gradually got better and on one of my shifts he was transferred out of ICU to continue his recovery.

This was a such a joy to see and collectively the team took heart from the difference they had made.

A nurse wearing a mask talking to a patient's family member, also wearing a mask
When it comes to visiting, we need to
balance the risks to patients and families
with the benefits Picture: iStock

What we need in the next phase of the pandemic

As we move into the next phase of the pandemic, there are things we should be mindful of.

For patients and their families, visiting is important. When planning how restrictions will work, we need to balance the risks of visiting with the benefits to patients and families.

And crucially, we need to consider the health and well-being of nursing staff. Nurses and care staff are emotionally and physically tired and have barely had a chance to recover from the first wave.

More staff may be off sick this time because of winter viruses such as flu and colds, putting more strain on the staff available to work.

Compassion fatigue could also be a factor, and that’s why good support for staff is essential. We need to continue to work together, laugh together, and encourage and support each other through the next few months.



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