Palliative care can be a double-edged sword. On one hand, it is a privilege to be part of someone's intimate dying experience; however, one must also manage patients' existential anxieties and try to support them to achieve the best death possible. In doing so, it can be argued that community nurses are being exposed themselves to the possibility and reality of their own death, which can often invoke death anxiety (Nyatanga and Nyatanga, 2011). During the COVID-19 pandemic, exposure to death took a different turn in terms of huge numbers of deaths being witnessed and the care being provided, with physical distancing and protective personal equipment (PPE) in place and often without any input from a patient's family and friends. While such care was necessary to control the spread of the virus and save lives, it also created an unfortunate disconnect with usual palliative care practice of being close to patients and their loved ones, and inadvertently made care somewhat impersonal. Community nurses and their employers would have made an effort to discover the best ways to support staff experiencing loneliness and suffering while trying to help patients to achieve some dignity in death. While every healthcare professional has made the delivery of the best care possible their focus during the duration of the pandemic, such constant exposure to death and dying episodes might have quietly created an environment for death anxiety to fester among community nurses.
Death anxiety is a phenomenon that may be experienced while caring in general, but is more prevalent in those caring for dying people (Nyatanga and Nyatanga, 2011). It can be argued that caring during the COVID-19 pandemic might have increased the possibility among caregivers of developing death anxiety. Therefore, understanding this phenomenon might assist in ameliorating its impact, so that community nurses continue to care for dying patients.
The nature of death anxiety
It is important to make the point that death is the extinction of life. Therefore, we can say that, inevitably, death is a primordial and primary source of anxiety experienced when we care, as most human beings tend to prioritise the preservation of both their own lives and the lives of those around them. Philosophers such as Martin Heidegger and Soren Kierkegaard have argued that we move from our natural day-to-day tendency to live without consideration of our mortality to being more mindful and aware of life and our need to exist (Magrini, 2006; Gron, 2008).
However, while thinking of our existence more consciously can be useful, it may also inevitably bring death to forefront of our thought processes, thereby increasing death anxiety levels. This may explain the continued presence of the death taboo, particularly in Western societies, as we attempt to block death from our everyday consciousness. However, avoidance of discussions around death does not make us immortal. We cannot escape death's inevitability, and experiencing death anxiety without resolution or exploration may lead to a negative impact to our wellbeing (Langford, 2002). Caring for dying patients may serve as a constant reminder of how fragile our existence is, and many healthcare professionals in the NHS, hospices and care homes would have encountered an unprecedented amount of deaths during the COVID-19 pandemic. It can be argued that the resultant death anxiety in these healthcare professionals could trigger potential negative outcomes on patient experience.
The way forward
First, individual reflections on how the pandemic has affected us and honesty about needing support to preserve our mental health is needed. Second, managers need to support staff by making it possible to freely report any negative impact experienced as a result of the pandemic, such as the fear of one's own death, the loss of loved ones or anxiety about an uncertain future. Of course, managers also need support; therefore, the larger organisation in which healthcare staff operate also has a responsibility to care and support all its employees during this difficult time.
Openly discussing death will also acknowledge that the historic and futile attempt to ignore its reality only allows death anxiety to develop unrecognised and unchecked, which will undermine community nurses' efforts to provide effective and person-centred palliative care.