The impact of caring, dying and death on healthcare staff during the COVID-19 pandemic.

The COVID-19 pandemic reminds us of our vulnerability – as of August 26th 2020 it has resulted in over 814,438 deaths (WHO). For many countries, the pandemic is an added burden on top of other disease outbreaks (Cov360), displaced communities in refugee camps, and war or famine (Cov360) (International Rescue Committee). At the forefront are healthcare staff, volunteers, humanitarian aid and key workers providing essential care.

At the forefront are healthcare staff, volunteers, humanitarian aid and key workers providing essential care.

Dying during a contagious disease outbreak disrupts the usual ways people can be with their loved ones in those precious last moments. Visiting may not be permitted or can only occur with restrictions such as with full PPE. Contact may only be via videoconferencing or with healthcare staff similarly ‘hidden’ behind PPE. Therefore, providing compassionate end-of-life care during a pandemic requires exceptional dedication and skill.

We systematically identified and reviewed the literature on the provision of end-of-life care during previous disease outbreaks and humanitarian disasters

How do healthcare staff manage to provide care at the end-of-life to patients in such challenging conditions? A literature review was conducted to understand the impact that providing end-of-life care during the pandemic might have on the mental health and wellbeing of staff providing this care. To do this, literature on the provision of end-of-life care during previous disease outbreaks and humanitarian disasters was systematically identified and reviewed to see what lessons could be learned from these situations (review protocol registered here). We included studies from previous Ebola (e.g. Hewlett & Hewlett, 2005) and SARs outbreaks (e.g. Leong et al., 2004), new work related to Covid-19 (e.g. Constantini et al., 2020), and studies of humanitarian disaster planning (e.g. Matzo et al., 2009).

The studies found that healthcare staff were motivated to carry out their role and reported team support and a sense of pride in their work. However, they were constantly faced with death and dying from their patients, colleagues, and relatives. They faced essential equipment and supply shortages, including of medicines and PPE. They experienced fear, isolation, helplessness, and stigmatization. Staff strove to retain dignity for their patients, providing compassionate care and creating meaningful connections with them during the last moments of their lives. Being prepared for the situation and being adaptable reduced some of their sense of fear. 

The findings from these studies of previous disease outbreaks resonate with the experience of healthcare providers during this pandemic. Therefore, better use of this evidence should be made to support staff to carry out their role, whilst maintaining their own mental health during such crises. Support should be available to staff and they must feel enabled and empowered to access it when they need it.

Lessons from the current pandemic itself should be used to determine the best ways to look after those who look after us. We need to offer greater support, in order to sustain, our healthcare staff.

28 August 2020

Report by Dr Bryony Porter

The University of East Anglia and National Institute for Health Research Applied Research Collaboration

On behalf of the review team, Amy Zile, Dr Guy Peryer, Dr Morag Farquhar & Prof Kristy Sanderson – University of East Anglia

This is a summary of research funded/supported by the National Institute for Health Research (NIHR) Applied Research Collaboration East of England. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

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