End-of-life care during COVID-19: opportunities and challenges for community nursing

Bowers, Ben; Pollock, Kristian; Oldman, Crystal; Barclay, Stephen

doi:10.12968/bjcn.2021.26.1.44

Cited by 27 publications

(36 citation statements)

References 18 publications

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“…Little has been written in the peer-reviewed literature about the experiences of community nurses during the pandemic, but the Royal College of Nurses surveyed its District and Community Nursing members and found similar themes to those raised by our participant [30]. Bowers et al raise similar concerns, particularly around palliative care, adding that the work of community teams has often been overlooked amid widespread media coverage of those working in hospital [31]. Although a reduction in GP home visits was felt to be necessary to reduce virus transmission, it is important that relationships are not damaged between doctors and their district nursing colleagues, or patients and their relatives.…”

Section: Discussionsupporting

confidence: 60%

COVID-19 at the Deep End: A Qualitative Interview Study of Primary Care Staff Working in the Most Deprived Areas of England during the COVID-19 Pandemic

Norman

Wildman

Sowden

2021

IJERPH

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COVID-19 is disproportionately impacting people in low-income communities. Primary care staff in deprived areas have unique insights into the challenges posed by the pandemic. This study explores the impact of COVID-19 from the perspective of primary care practitioners in the most deprived region of England. Deep End general practices serve communities in the region’s most socioeconomically disadvantaged areas. This study used semi-structured interviews followed by thematic analysis. In total, 15 participants were interviewed (11 General Practitioners (GPs), 2 social prescribing link workers and 2 nurses) with Deep End careers ranging from 3 months to 31 years. Participants were recruited via purposive and snowball sampling. Interviews were conducted using video-conferencing software. Data were analysed using thematic content analysis through a social determinants of health lens. Our results are categorised into four themes: the immediate health risks of COVID-19 on patients and practices; factors likely to exacerbate existing deprivation; the role of social prescribing during COVID-19; wider implications for remote consulting. We add qualitative understanding to existing quantitative data, showing patients from low socioeconomic backgrounds have worse outcomes from COVID-19. Deep End practitioners have valuable insights into the impact of social distancing restrictions and remote consulting on patients’ health and wellbeing. Their experiences should guide future pandemic response measures and any move to “digital first” primary care to ensure that existing inequalities are not worsened.

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Section: Discussionsupporting

confidence: 60%

COVID-19 at the Deep End: A Qualitative Interview Study of Primary Care Staff Working in the Most Deprived Areas of England during the COVID-19 Pandemic

Norman

Wildman

Sowden

2021

IJERPH

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“…There is a lack of previous research to inform practice, service delivery, or policy, 9 , 16 despite the importance of the provision of high-quality end-of-life care in a pandemic. 17 , 18 Responders in this study perceived that their role in the pandemic response has received less focus than the response of hospital care.…”

Section: Discussionmentioning

confidence: 99%

Community end-of-life care during the COVID-19 pandemic: findings of a UK primary care survey

et al. 2021

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BackgroundThousands of people in the UK have required end-of-life care in the community during the COVID-19 pandemic. Primary healthcare teams (general practice and community nursing services) have provided the majority of this care, alongside specialist colleagues. There is a need to learn from this experience in order to inform future service delivery and planning.AimTo understand the views of general practitioners and community nurses providing end-of-life care during the first wave of the COVID-19 pandemic.Design & settingA web-based, UK-wide questionnaire survey circulated via professional general practice and community nursing networks during September and October 2020.MethodResponses were analysed using descriptive statistics and an inductive thematic analysis.ResultsValid responses were received from 559 individuals (387 community nurses, 156 General Practitioners (GPs) and 16 unspecified role), from all regions of the UK. The majority reported increased involvement in providing community end-of-life care. Contrasting and potentially conflicting roles emerged between GPs and community nurses. There was increased use of remote consultations, particularly by GPs. Community nurses took greater responsibility in most aspects of end-of-life care practice, particularly face-to-face care, but reported feeling isolated. For some GPs and community nurses, there has been considerable emotional distress.ConclusionPrimary healthcare services are playing a critical role in meeting increased need for end-of-life care in the community during the COVID-19 pandemic. They have adapted rapidly, but the significant emotional impact, especially for community nurses, needs addressing alongside rebuilding trusting and supportive team dynamics.

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“…Much of the media attention, and government decisions, focussed on overwhelmed hospitals and intensive care units (ICUs). However, there was less attention afforded to other settings where a substantial amount of health care, including palliative and end of life care, took place -community health and social care services such as primary care, district nursing, or care homes (Bowers et al, 2021;Oluyase et al, 2020). In particular, non-NHS hospice services experienced rapid and sizeable changes affecting all aspects of care and support (Sleeman et al, 2021).…”

Section: Resultsmentioning

confidence: 99%

“…The pandemic has been a catalyst for these initiatives, bringing immediate changes affecting almost every aspect of providing hospice care and support, from clinical practice to interpersonal and social relations (Dunleavy et al, 2021). The shift in location of care has also led to an expanded case load for community staff, with community nurses having to carry out more roles than usual (Bowers et al, 2021;. For example, completing do-not-resuscitate forms, being involved in medical decisions, and verifying death certificates (Bowers et al, 2021).…”

Section: Places Of Care: Towards Integrated Hospice Care In the Communitymentioning

confidence: 99%

“…The shift in location of care has also led to an expanded case load for community staff, with community nurses having to carry out more roles than usual (Bowers et al, 2021;. For example, completing do-not-resuscitate forms, being involved in medical decisions, and verifying death certificates (Bowers et al, 2021).…”

Section: Places Of Care: Towards Integrated Hospice Care In the Communitymentioning

confidence: 99%

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What do we know about the impact of the Covid-19 pandemic on hospices? A collaborative multi-stakeholder knowledge synthesis

MacArtney¹,

Eccles²,

Fleming³

et al. 2021

healthopenres

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Background: Prior to undertaking a study looking at the effects of the COVID-19 pandemic upon lived experiences of hospice services in the West Midlands, we sought to identify the range of issues that hospice service users and providers faced between March 2020 and July 2021, and to provide a report that can be accessed and understood by all interested stakeholders. Methods: We undertook a collaborative multi-stakeholder approach for scoping the range of potential issues and synthesising knowledge. This involved a review of available literature; a focus group with hospice stakeholders; and a collaborative knowledge exchange panel. Results: The literature on the effects of the COVID-19 pandemic on hospices remains limited, but it is developing a picture of a service that has had to rapidly adapt the way it provides care and support to its service users, during a period when it faced many fundamental challenges to established ways of providing these services. Conclusions: The impacts of many of the changes on hospices have not been fully assessed. It is also not known what the effects upon the quality of care and support are for those with life-limiting conditions and those that care for them. We found that the pandemic has presented a new normative and service context in which quality of care and life itself was valued that is, as yet, poorly understood.

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End-of-life care during COVID-19: opportunities and challenges for community nursing

Cited by 27 publications

References 18 publications

COVID-19 at the Deep End: A Qualitative Interview Study of Primary Care Staff Working in the Most Deprived Areas of England during the COVID-19 Pandemic

COVID-19 at the Deep End: A Qualitative Interview Study of Primary Care Staff Working in the Most Deprived Areas of England during the COVID-19 Pandemic

Community end-of-life care during the COVID-19 pandemic: findings of a UK primary care survey

What do we know about the impact of the Covid-19 pandemic on hospices? A collaborative multi-stakeholder knowledge synthesis

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