A study on end-of-life care in nursing homes during the COVID-19 pandemic reveals inadequate human, material and training resources
The nursing home professionals who participated in this research reported feelings of helplessness, abandonment and dehumanization
The results have been published in palliative medicine, one of the world's leading palliative care scientific journals
Research carried out by the Granada Biosanitary Research Institute (ibs.GRANADA) and the University of Granada (UGR) on end-of-life care in nursing homes during the COVID-19 pandemic reveals that human resources, materials and training were inadequate.
The article “Inadequate human, material and training resources: a qualitative evaluation of the objectives of the NUHELP end-of-life care program in the context of the COVID-19 pandemic” (Inadequate human resources, equipment and training: A qualitative assessment of the objectives of the NUHELP end-of-life care program in the context of the COVID-19 pandemic) has been published in Palliative Medicine, one of the world's leading palliative care scientific journals.
Emilio Mota Romero and Rafael Montoya Juárez, researchers from the group Ee12-HYGIA: Care and conditioning factors in health of the ibs.GRANADA, professors of the Department of Nursing of the UGR and of the Group “Psychosocial and Transcultural Aspects of Health and Illness” (Group CTS-436), Daniel Puente Fernández, professor at the University of Jaén and from the same research group, as well as Carmen Rodríguez Pertíñez from the Hogar Beato Fray Leopoldo Residence, Gema Arbol Fernández from the Hazards Health Center (Granada) and Socorro Moreno Guerrero, from the Residencia Nuestra Señora de Fonseca in Granada.
The objective of this article was to describe how the COVID-19 pandemic affected nursing homes and primary care centers linked to them. Specifically, it focused on how professionals tried to achieve the goals of an intervention program to improve care at the end of life (NUHELP Program) developed for these same centers just before the pandemic.
The results of this work are novel because, although much has been said about it, there are few studies that narrate how professionals have experienced care at the end of life in the first person in a context as punished as nursing homes during the first waves of the pandemic. The article provides concrete testimonies of the experience of the workers of centers for the elderly, which crossed the limits of what until then they knew as their professional performance.
Regarding the methodology, the researchers conducted 20 interviews with professionals, 13 from nursing homes in Granada and Jaén, and 7 nurses from their reference health centers, who worked in the centers between March and November 2020. coinciding with the first waves of the pandemic.
The interviews focused on these five major themes:
- Comprehensive assessment and monitoring of a personalized plan based on the palliative needs detected.
- Provide clear and accessible information.
- Collect and record early decision making.
- Provide anticipatory care for loss and bereavement.
- Refer those patients to specialized palliative care services based on their palliative complexity.
The interviews were conducted online, and the professionals were asked to describe concrete examples and how they had experienced this reality. A qualitative analysis of the previous themes was carried out, to which a final theme of personal experiences was added.
The results show that the COVID pandemic has revealed multiple previous gaps in end-of-life care in nursing homes:
Thus, comprehensive assessments of the residents were not carried out due to the intense workload and excessive staff turnover. In many cases, the assessments and monitoring focused solely on aspects related to COVID.
With regard to information, the information needs of the residents were not met. The professionals used the technologies (mobile, videoconference) to communicate with the relatives of the residents who constantly demanded information. In some cases, non-regular professionals or those who did not provide direct care to patients were in charge of providing information, with the limitations that this entails.
Advance decision-making as such was not carried out either, but rather the decisions were linked solely to the transfer of the resident to the hospital. Many professionals lament that residents' views were not sufficiently taken into account in decision-making.
The UGR study also reflects that measures were carried out to allow the relatives of the residents to spend the last moments of their lives with them, sometimes even against the strict restrictions imposed in the residences. The professionals in this study state how they foresee the appearance of a complicated duel in those cases in which there was no farewell.
Referral of complex cases to specialized palliative care services depended on coordination between primary care centers and nursing homes. While some centers expressed their satisfaction in this regard, other professionals felt abandoned by health institutions.
In general, the professionals interviewed in this work express feelings of impotence, abandonment and dehumanization. The authors conclude that more human and material resources and specific training in palliative care in nursing homes are needed.
Bibliographic reference:
Mota Romero, E., Puente Fernández, D., Rodríguez Pertíñez, C., Arbol Fernández, G., Moreno Guerrero, S., & Montoya Juárez, R. (2022). Inadequate human resources, equipment and training: A qualitative assessment of the objectives of the NUHELP end-of-life care program in the context of the COVID-19 pandemic. Palliative Medicine. https://doi.org/10.1177/02692163221103099