Travis Sheppard
"…we were thinking, these are our last months with him and we're looking at him through a window or through Facetime, you know?"
~ Study participant
Researchers at Western Regional School of Nursing and the provincial health authority will soon publish a study that examines the devastating effects of COVID-19 restrictions on families and dying loved ones during palliative care.
Judith Strickland
Nurse Educators Travis Sheppard and Judith Strickland and Sandra Lush of Spiritual Health (formerly Western Health) are the authors of the study, which is titled Fighting for Connection: A Socially Distanced Grief Experience.
"The idea emerged due to the restrictions associated with the COVID-19 pandemic and their impact on dying patients," said Mr. Sheppard. "Their family members were not able to carry out customs and rituals which may have brought support and comfort."
Sandra Lush
Using Grounded Theory methodology, the researchers conducted 16 individual interviews to ascertain how participants fought to connect with dying relatives as they dealt with imposed restrictions that made it difficult, if not impossible, for them and their family members to spend time with their loved ones. While the restrictions were intended to make people feel protected and safe, for those who were trying to be present with their loved ones, or already bereaved and grieving, a major consequence was the loss of human connection.
The researchers documented several strategies employed by the participants to cope with the imposed restrictions and resulting loss of connection, such as:
-
Making calls - Participants described having to make calls because they were not allowed to visit their loved ones in-person, depending on the alert level within the province at the time of the illness and death of their loved one. These calls ranged from speaking with a nurse or physician about the condition of their loved one, to making critical decisions such as who was going to be on the visitors list for a healthcare facility and, upon their loved one's passing, who could attend the funeral.
-
Fighting against "blunted senses" - The necessity of wearing a face mask and in some instances additional PPE such as gowns, gloves and shields. Limited interactions due to physical barriers made of glass such as windows and electronic devices (e.g. tablets/cellphones) that were used to minimize the spread of infectious droplets and airborne pathogens
-
Grasping for time - Utilizing as much time as possible; taking some precious time away to fight
Seeking permissions - Appealing to people in authority, elevating concerns to higher levels, dealing with funeral authorities
-
Managing imposed responsibilities - Participants viewed the guidelines as rules or laws that had to be followed (family/own expectations). Participants followed the guidelines, however, because people were monitoring visitors (facilities and organizations). When entering a healthcare facility, the weight of responsibility increased. People were instructed to put on a mask and wait, stand back, grieving from a distance (socially distanced grief)
"The long-term impacts of COVID-19 restrictions on grief and loss are unknown," said Mr. Sheppard. "Due to the constant fight for connection between family and their dying loved one, we feel it is important to consider the possibility of complicated and unresolved grief."
With that in mind, the researchers suggest that healthcare professionals should be careful to complete a thorough assessment of client history, particularly asking about any form of experiential loss during a period of pandemic restrictions.
A number of recommendations were recorded from the participants, including:
-
Dying was a special circumstance that should have been taken into account - there should have been exceptions
-
Palliative care was important, not only end of life
-
Plans should be discussed with the entire care team, and messaging should be consistent
-
People should have been trusted to follow the guidelines
-
Family members should be allowed more than one visit per day