Nurses at the COVID-19 Bedside: Generalist Palliative Care Support
Background: The COVID-19 pandemic has brought to light the unpreparedness of the United States’ healthcare system in dealing with a public health emergency. Nurses at the bedside of patients suffering and dying from the virus have faced numerous challenges. One of the most significant may be the lack of generalist palliative care education and training necessary to maintain patient comfort in the face of COVID-19 related symptom clusters and comfortably provide care during the dying and post-mortem periods. These areas have typically been the specialty of hospice and palliative care nurses together with interdisciplinary teams. However, the United States already faced a shortage of nurses with specialty and generalist palliative care prior to the pandemic. Further, nurses have been faced with new and triggered trauma as a result of the demands of providing care with inadequate supplies, medication and protective equipment, and many deaths happening in rapid succession, including those of colleagues and family. Adding to the trauma potential and moral distress, has been the news of significantly higher infection and death rates for younger Black, Indigenous, People of Color, occurring during a time of national attention to anti-Black police violence and institutional racism.
Objective: Professional organizations have disseminated resources to help nurses provide appropriate and adequate care during COVID-19. These resources, however, require time to locate, sort through and evaluate for usefulness in particular clinical settings. To assist nurses with this process, especially newer nurses and nurses with little palliative or end of life care experience, we leveraged our palliative care expertise to present a series of three 30-minute webinars which curated a selection of generalist palliative care resources covering content related to symptom management and care of dying persons, mindfulness and self-care practices for nurses, and the social justice imperative for the nursing profession to address COVID-19 related health disparities. The webinars were publicized nationally, locally, and regionally to nursing colleagues and students. There was no cost to attend and the webinars are archived for open access use and sharing at the Palliative CARE to Support Practice website (https://www.palliativepracticesupport.info/).
Findings: Participants included undergraduate and graduate nursing students, nurses, and educators, some of whom had worked the frontlines of the COVID-19 outbreak in Massachusetts. Each webinar presentation was followed by a Q&A/discussion session during which participants were very engaged in sharing their experiences on the frontlines and dialoguing about how to support nurses during the pandemic. A total of 12 participants who completed surveys after each webinar rated the webinars as good-to-excellent, and most participants indicated an increase in knowledge, with the greatest increase occurring for the health inequity webinar. The objective of the webinar series was to provide a brief overview and curated generalist palliative nursing resources to be personalized and applicable to a variety of nursing settings; an overview of moral distress, trauma, and self-care methods; and an overview of the health disparities evidenced by the COVID-19 pandemic. At the conclusion of this poster review, the participants will be able to discuss COVID-19 specific generalist palliative care nursing clinical needs and educational resources to meet those needs.
Author: Olga Ehrlich, PhD, RN, CHPN, UMass Amherst, College of Nursing