Authors (including presenting author) :
HO SF(1), CHAN CY(1), WONG MC(1), WONG CS(1)
Affiliation :
(1)Department of Clinical Oncology, New Territories West Cluster, Hospital Authority, HKSAR
Introduction :
Patients all over the world have been dying alone in COVID-19 pandemic. Visits are restricted. Patients feel isolated. Relatives do not have any opportunity to grieve at all, followed by complaints, fatigue and burnout. Rapport is often lost between health care workers, patients and relatives. Staffs feel overloaded and unappreciated. Over 590 deaths were recorded in the NTWC cancer palliative ward in 2020. Handling death and bereavement care has become more challenging to health care providers.
Objectives :
Maintain social and emotional engagement in end-of-life care during COVID-19 pandemic
Reduce the emotional effects of deaths on patients and relatives
Methodology :
Keep social distance but maintain social and emotional engagement. More phone conversations and tele-interviews have been conducted between health care workers, relatives and patients. Nurses spent more time on phone-call pre-bereavement care and psychologically prepared for patient’s impending death so that relatives have a chance to fully grieve their losses. Relatives were encouraged to keep in touch with patients by phone or video calls and treasure the time they have. Early engagement is highly recommended for patients as sudden death could be happened anytime.
To improve patient and public understanding of restricted visiting, apart from nurses, patient care assistants were deployed to the entrance of ward. Apart from entry screening, the requests and enquiries from the public were addressed to improve mutual communication. The nursing team openly apologized for the restricted visits and explained the reasons. Very limited compassionate ground was given to dying patients. Every day, difficult decisions are made.
The team tried to make people felt connected instead of abandoned. In 2020, Nurses provided over 4000 sessions of psychosocial support to patients and relatives allowing them to express their feelings, have a grief support, tell stories and say goodbye. No patient wants to die alone. More advanced technologies should be provided for video calls and USB chargers for patients during hospitalization.
Result & Outcome :
In 2020, valuable experience was gained. The ward tried to deliver best practice of psychosocial support and bereavement care to over 590 families with limited time and resources. Every family was engaged but it was far from being sufficient. More complaints have been received during the pandemic. We also found compassionate fatigue and moral distress among staffs. Other than loss of life, emotional costs are heavy as well.
