Even the most confident of long-term care staff, sure of their knowledge and skills, reported “notable difficulties” providing palliative and end-of-life care during the COVID-19 pandemic, finds a new study across nine nursing homes. The results underscore the importance of providing psychosocial support for LTC care providers, researchers say.
The investigation took place in Ontario, Canada, in facilities participating in the Communication at End-of-Life Program between August 2019 and March 2020. The program seeks to improve LTC staff members’ competencies in providing palliative care and end-of-life care to residents and their families.
The researchers sought to capture staff members’ confidence level in their skills and knowledge, their attitudes toward death and dying, relationships with residents and families and level of participation in care. They also identified facilitators and barriers to providing care during the pandemic.
Nineteen staff members responded to the survey, 28 participated in semi-structured interviews, and 8 participated in both. Participants represented a variety of positions, including personal support workers, nurses, and allied healthcare staff and administrators.
Challenges, despite training
Study participants expressed having notable challenges that were “severe and negative,” despite being palliative care leaders and champions within their facilities and receiving added training in palliative and end-of-life communications through the CEoL Education Program.
Issues that impinged on confidence and care delivery competency included visitation restrictions, staffing shortages, added workload and psychological stress, lead author Annie H. Sun, MPH, of the Bruyère Research Institute, Ottawa, Ontario, reported.
“Participants reported notable deterioration in confidence and comfort in care delivery, as well as challenges in providing patient-centered palliative and end-of-life care during the pandemic,” Sun reported.
Top challenges
Visitation restriction resulted in residents feeling lonely and isolated, and impeded staff members’ abilities to build supportive relationships with families, she noted. Single-site work restriction implemented by Canada’s provincial governments and the increase in illness increased workload. Staff and residents also contended with psychological stress caused by fear of COVID-19 infection and transmission, hindering care provision.
Maintaining confidence
Despite these struggles, 90% of study participants reported that they were able to maintain a high level of confidence and meet residents’ end-of-life needs. And nearly half of the interview participants said that support from co-workers and management remained consistent. More frequent discussions about residents’ goals of care necessitated by pandemic circumstances helped raise confidence as well, they reported.
Reducing burnout
Although the study sample was small, and therefore not fully generalizable, the results highlight the critical importance of psychological support needed to reduce the level of burnout among health and social care workers, Sun and colleagues said.
“Our findings emphasize the importance of providing ongoing psychosocial support to staff in their recovery in the post-pandemic period and beyond,” the researchers concluded.
Full findings, including more details of specific care challenges, were published in JAMDA.
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