Complexity of Nurse Practitioners' Role in Facilitating a Dignified Death for Long-Term Care Home Residents during the COVID-19 Pandemic.

Shirin Vellani,Veronique Boscart,Katherine S Mcgilton,Astrid Escrig-Pinol,Souraya Sidani,Nancy Zheng,Lydia Yeung,Alexia Cumal,Alexandra Krassikova

doi:10.3390/jpm11050433

Abstract

Due to the interplay of multiple complex and interrelated factors, long-term care (LTC) home residents are increasingly vulnerable to sustaining poor outcomes in crisis situations such as the COVID-19 pandemic. While death is considered an unavoidable end for LTC home residents, the importance of facilitating a good death is one of the primary goals of palliative and end-of-life care. Nurse practitioners (NPs) are well-situated to optimize the palliative and end-of-life care needs of LTC home residents. This study explores the role of NPs in facilitating a dignified death for LTC home residents while also facing increased pressures related to the COVID-19 pandemic. The current exploratory qualitative study employed a phenomenological approach. A purposive sample of 14 NPs working in LTC homes was recruited. Data were generated using semi-structured interviews and examined using thematic analysis. Three categories were derived: (a) advance care planning and goals of care discussions; (b) pain and symptom management at the end-of-life; and (c) care after death. The findings suggest that further implementation of the NP role in LTC homes in collaboration with LTC home team and external partners will promote a good death and optimize the experiences of residents and their care partners during the end-of-life journey.

Highlights

Introduction published maps and institutional affilIndividuals transition into long-term care (LTC) homes closer to the end of their life, often with multiple comorbid conditions, higher levels of frailty and complex care needs [1,2]
Nurse practitioners (NPs) attested to the importance of implementing a palliative approach to care where the focus is on the residents’ quality of life, while adhering to the safety requirements necessitated by the COVID-19 pandemic
One NP explained: This was time-consuming, but we were very successful in bringing families into sort of an understanding of reality and acceptance of end-of-life issues . . . advance-care planning was a huge, huge part of my time–helping families to move along that continuum

Summary

Introduction

Introduction published maps and institutional affilIndividuals transition into long-term care (LTC) homes closer to the end of their life, often with multiple comorbid conditions, higher levels of frailty and complex care needs [1,2]. Within two years of admittance to LTC homes, most residents die [3,4]. As such, integrating a palliative approach to care would be the best practice, yet this approach is not implemented in the majority of LTC homes [5]. While death is an unavoidable ending for LTC residents, promoting a good death is an important goal of palliative and end-of-life (EOL) care [7,8]. This has become even more pressing during the SARS Coronavirus Disease-2019 (COVID-19) pandemic, where a large percentage of deaths were among LTC home residents, ranging from 8% in South Korea, 39% in the iations

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Conclusion