Laboratory of Forensic Medicine & Toxicology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Postgraduate Program on Bioethics, Laboratory of Bioethics and Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Front Public Health. 2022 Oct 21;10:981780. doi: 10.3389/fpubh.2022.981780. eCollection 2022.
In Greece, there is still limited research on death in isolation due to COVID-19. This deserves attention because of the recent financial crisis, which profoundly impacted public health, and the high relevance of the Hippocratic tradition to the moral values of clinical practice.
A prospective qualitative study using in-depth interviews with 15 frontline nursing practitioners working in a COVID-19 ward or intensive care unit (ICU) was conducted from July 2021 to December 2021.
The inability of family members to say a final goodbye before, during, or after death by performing proper mourning rituals is extremely inhuman and profoundly impacts the mental health status of patients, family members, and nursing practitioners. Patients and their family members strongly desire to see each other. Epidemiology, liability, and proper nursing performance emerged as reasons for the enforced strict visitation restrictions. Participants emphasized that visitations should be allowed on an individual basis and highlighted the need for the effective use of remote communication technology, which, however, does not substitute for in-person contact. Importantly, physicians allowed "clandestine" visits on an individual basis. Nursing practitioners had a strong empathic attitude toward both patients and their families, and a strong willingness to provide holistic care and pay respect to dead bodies. However, they also experienced moral distress. Witnessing heartbreaking scenes with patients and/or their families causes nursing practitioners to experience intense psychological distress, which affects their family life rather than nursing performance. Ultimately, there was a shift from a patient-centered care model to a population-centered care model. Furthermore, we identified a range of policy- and culture-related factors that exaggerate the negative consequences of dying alone of COVID-19.
These results reinforce the existing literature on several fronts. However, we identified some nuances related to political decisions and, most importantly, convictions that are deeply rooted in Greek culture. These findings are of great importance in planning tailored interventions to mitigate the problem of interest and have implications for other similar national contexts.
在希腊，由于 COVID-19 而导致的隔离死亡研究仍然有限。由于最近的金融危机对公共卫生产生了深远影响，以及希波克拉底传统对临床实践道德价值观的高度相关性，这一点值得关注。
我们于 2021 年 7 月至 12 月期间开展了一项前瞻性定性研究，采用深入访谈的方式对在 COVID-19 病房或重症监护病房（ICU）工作的 15 名一线护理从业者进行了调查。
患者及其家属在生前、生时或死后都无法进行适当的哀悼，这是极其不人道的，对患者、家属和护理从业者的心理健康状况都产生了深远的影响。患者及其家属非常希望见到对方。流行病学、责任和适当的护理表现是实施严格探视限制的原因。参与者强调探视应该根据个人情况进行允许，并强调需要有效利用远程通讯技术，但这并不能替代面对面的接触。重要的是，医生会根据个人情况允许“秘密”探视。护理从业者对患者及其家属都怀有强烈的同理心，强烈希望提供全面的护理并尊重死者。然而，他们也经历了道德困境。目睹患者和/或其家属令人心碎的场景会使护理从业者经历强烈的心理困扰，这会影响他们的家庭生活而不是护理表现。最终，从以患者为中心的护理模式转变为以人群为中心的护理模式。此外，我们确定了一系列与政策和文化相关的因素，这些因素夸大了 COVID-19 孤独死亡的负面后果。
这些结果在几个方面加强了现有文献。然而，我们确定了一些与政治决策相关的细微差别，最重要的是，与希腊文化中根深蒂固的信念相关的细微差别。这些发现对于制定有针对性的干预措施以减轻这一问题具有重要意义，并对其他类似的国家背景具有启示意义。
