Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.
Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
Scand J Caring Sci. 2022 Sep;36(3):769-781. doi: 10.1111/scs.13038. Epub 2021 Oct 9.
The COVID-19 pandemic affects care practices for critically ill patients, with or without a COVID-19 infection, and may have affected the experience of dying for patients and their relatives in the physical, psychological, social and spiritual domains.
To give insight into aspects of end-of-life care practices that might have jeopardised or supported the dignity of the patients and their family members during the first wave of the COVID-19 pandemic in the Netherlands.
A qualitative study involving 25 in-depth interviews with purposively sampled bereaved relatives of patients who died during the COVID-19 pandemic between March and July 2020 in the Netherlands. We created a dignity-inspired framework for analysis, and used the models of Chochinov et al. and Van Gennip et al. as sensitising concepts. These focus on illness-related aspects and the individual, relational and societal/organisational level of dignity.
Four themes concerning aspects of end-of-life care practices were identified as possibly jeopardising the dignity of patients or relatives: 'Dealing with an unknown illness', 'Being isolated', 'Restricted farewells' and 'Lack of attentiveness and communication'. The analysis showed that 'Meaningful end-of-life moments' and 'Compassionate professional support' contributed to the dignity of patients and their relatives.
This study illuminates possible aspects of end-of-life care practices that jeopardised or supported dignity. Experienced dignity of bereaved relatives was associated with the unfamiliarity of the virus and issues associated with preventive measures. However, most aspects that had an impact on the dignity experiences of relatives were based in human action and relationships. Relatives experienced that preventive measures could be mitigated by health care professionals to make them less devastating.
COVID-19 大流行影响了重症患者的护理实践，无论是否感染 COVID-19，并且可能已经影响了患者及其亲属在身体、心理、社会和精神领域的临终体验。
深入了解 COVID-19 大流行第一波期间荷兰临终关怀实践中可能危及或支持患者及其家属尊严的方面。
一项定性研究，涉及对 25 名在荷兰 COVID-19 大流行期间于 2020 年 3 月至 7 月间去世的患者的丧亲亲属进行了有针对性抽样的深入访谈。我们创建了一个基于尊严的分析框架，并使用了 Chochinov 等人和 Van Gennip 等人的模型作为敏感概念。这些概念侧重于与疾病相关的方面以及个人、关系和社会/组织层面的尊严。
确定了可能危及患者或亲属尊严的临终关怀实践方面的四个主题：“应对未知疾病”、“隔离”、“限制告别”和“缺乏关注和沟通”。分析表明，“有意义的临终时刻”和“富有同情心的专业支持”有助于患者及其亲属的尊严。
本研究阐明了可能危及临终关怀实践尊严的方面。丧亲亲属经历的尊严与病毒的陌生性以及与预防措施相关的问题有关。然而，对亲属尊严体验产生影响的大多数方面都基于人的行动和关系。亲属们发现，医护人员可以减轻预防措施的破坏性。
