The COVID-19 pandemic has left a trail of pain and suffering for health professionals, people who were affected by the virus and survived, bereaved families and, probably, children born during the pandemic. It has overwhelmed weak healthcare systems (Radbruch et al, 2020, torn up communities and has had a devastating impact on individual families. Although the restrictions have been necessary, they have increased isolation among patients and their families. For example, people have died without their loved ones by their side. Most people who died from COVID-19 were in hospitals, nursing and care homes or hospices, again increasing the isolation experienced in death. Any care given after the pandemic ends should consider such death experiences in terms of the impact of the lack of bereavement rituals on the bereaved.
Some sections of the healthcare system were not used to witnessing deaths, but the pandemic changed all that. At the beginning of lockdown in the UK, I recall joining my local trust to train staff working in mental health services about death and dying and sharing knowledge and skills regarding end-of-life care. It would have been ideal to have provided basic palliative care education and training to all health professionals well before the pandemic. Such training could have been useful not only for nursing students but all healthcare students, including medical students. It is also important to offer refresher training workshops in palliative care for generalist health professionals.
Impact of COVID-19
It is most likely, given the disproportionate impact of COVID-19 on people of colour in the UK, that the same population group will experience a high post-pandemic burden. People affected by the virus may continue to experience symptoms, some chronic and debilitating, after recovering from the initial infection. It can be argued that these chronic symptoms lead people in the survivorship phase similar to that experienced by people living with or beyond cancer. Health professionals can approach care for these people in a holistic way and support people to adjust and live with comfort. Like living with cancer, these people will also need psychological support, because of the wider impact of the virus on their functioning and wellbeing. Very often when this happens, lifestyle changes are inevitable, and this can also have an impact on interpersonal relationships. People with multiple co-existing conditions are particularly vulnerable to COVID-19. Therefore, providers of palliative care and other services need to come up with strategies to ameliorate the post-COVID-19 burden and be ready to implement them as the pandemic ends. Some of the strategies listed below are from Radbruch et al (2020), who took a global approach, but these can be adapted to suit local environments.
Strategies for post-COVID-19 palliative care
Health professionals offering such care will also need looking after. Access should be made available to culturally sensitive counselling. Social support in a socially distanced way should be promoted. Offering support to health professionals benefits their patients indirectly by ensuring continuity of care (staff not going off sick) and, therefore, better management of chronic symptoms.
Finally, one wonders about the role technology that can play by equipping community nurses with telehealth capabilities to virtually conduct home-based palliative care assessments. Such innovation can ensure that dying can, once again, be dignified. For community nurses, witnessing and being part of such death experiences can go a long way in offering job satisfaction and enhanced wellbeing.