„Ich stehe jeden Dienst mit mir selbst im Konflikt“–„Moral distress“ bei Altenpflegenden während der COVID-19-Pandemie

Abstract

Zusammenfassung Hintergrund Aufgrund der COVID-Pandemie-bedingten Veränderungen sind Pflegende im Setting der stationären Altenpflege besonderen Belastungen ausgesetzt und können in Bezug auf ihre moralische Verantwortung Dilemmata erleben. Ziel Ziel dieser Untersuchung ist es, die Auswirkungen und Wahrnehmungen hinsichtlich der Entstehung von Moral distress von Pflegenden im Setting der Altenpflege während der SARS-CoV-2-Pandemie in Deutschland zu explizieren und daraus Schlussfolgerungen für die Gestaltung von Pflege in stationären Pflegeeinrichtungen zu ziehen. Methode Auf der Basis einer Subgruppenanalyse (n = 510) des qualitativen Surveys der COVID-19-Pflegestudie werden Wahrnehmungen von Altenpflegenden während der Pandemie in Deutschland dargestellt und hinsichtlich der Entwicklung von Moral distress ausgewertet. Ergebnisse Durch die Analyse können 5 Kategorien („Dass wir keine Zeit haben, um ordentlich pflegen zu können“, „Vereinsamung“, „Konflikte mit Angehörigen und Bewohnern“, „Ständige Angst um Patientensicherheit, aber auch um die eigene Sicherheit“ und „Trauer, Stress und Wut“) identifiziert werden, die differenzierte Kriterien zum Entstehen von Moral distress bei den Altenpflegenden sowie deren Auswirkungen darlegen. Schlussfolgerungen Aus den Erkenntnissen ist zu schlussfolgern, dass strukturelle und fachliche Lösungen entwickelt werden müssen, die es Pflegenden ermöglichen, ihr eigenes Arbeitsumfeld zu gestalten und fachliche Versorgungsentscheidungen selbstständig zu übernehmen.

Differences in Stakeholders’ Perception of the Impact of COVID-19 on Clinical Care and Decision-Making

“…Proper healthcare management support can avoid therapists’ pandemic frustration, maintain physical and mental health, and a healthy psychosocial work environment [ 24 , 25 ]. To avoid the dissociated perception of the pandemic impact between patients and professionals, potentially resulting in impaired SDM, a specific awareness should be provided and trained for professionals that are dealing with clinical care under the conditions of a pandemic [ 26 ]. Further research needs to be done for the evaluation of perception dynamics over the course of a pandemic and its relationship to incidence developments.…”

Psychosocial burdens in palliative care – a longitudinal cohort study in nursing homes and impacts of the COVID-19 pandemic

“…No study specifically addressing the psychosocial burdens of palliative care among nursing staff working in German nursing homes and the ways in which these burdens were affected by the COVID-19 pandemic could be found. However, six studies that analysed the impact of the pandemic on psychosocial burdens in German nursing homes in general were identified [ 14 , 17 – 21 ], two of them which also used the COPSOQ questionnaire [ 17 , 19 ]. However, COVID-19 exposure and experiences may have varied due to the focus on different regions in Germany, as the federal states implemented different COVID-19 measures over time.…”

“…Consistent with the results of this study, they found negative changes in the category ‘Role conflicts’ [ 17 ]. In other studies, staff working at nursing homes reported higher work demands due to isolation and lockdowns, which not only changed their role as they tried to compensate residents’ families, social workers and other visitors in terms of social contact but also caused them to feel compassion for residents, leading to guilty consciences whenever the lack of time resources prevented them from providing adequate care to residents [ 18 , 21 ]. This situation might have led to role conflicts as a possible explanation of the relevant negative changes within this category according to the present study.…”

“…As of November 2022, almost 350 thousand COVID-19 cases had been reported among nursing home residents in Germany [ 16 ], and approximately half of all COVID-19 deaths were among nursing home residents [ 14 ]. As a result, nursing homes have been greatly impacted by the pandemic, leading to a significant increase in the physical and mental workloads [ 14 , 17 – 21 ]. High rates of sick leave and staff shortages, daily readjustments of work processes, limited possibilities to exchange work information with colleagues, the increased mortality rate of residents with COVID-19 and fears of becoming infected and infecting residents are perceived burdens [ 14 , 17 – 21 ].…”

“…Although some studies have investigated the impacts of the pandemic on palliative care in Germany [ 23 , 25 – 30 ] or on the workloads faced by nursing home staff [ 17 , 21 ], no study that specifically addressed the psychosocial burdens of palliative care in nursing staff working in German nursing homes and the impact of the COVID-19 pandemic could be found. Therefore, this research focused on the questions of how the psychosocial burdens of palliative care in nursing homes have been affected by the COVID-19 pandemic and how these psychosocial burdens differ from those of general care.…”