Abstract and Introduction
Abstract
The COVID-19 pandemic has created a global health crisis. Novel and intolerable pressures have been placed upon nurses affecting their capacity to provide care. The aim of this exploratory study was to determine the impact of the COVID-19 pandemic on nursing care delivery, the empathetic response of nurses to their patients and family members, and the emotional and physical well-being of the nurses. Four frontline nurses were interviewed while in the midst of the pandemic. Common themes emerged from analysis of the nurses' narratives and included changes in role, increased workload, depersonalized and mechanical care delivery, communication challenges with patient and family members, deficits in palliative care education, perceived poor administrative support, and physical/emotional exhaustion. Clinical leaders and nursing staff have opportunities to engage in supportive endeavors, which can restore focus and regain positive perceptions, strengthen coping skills, and deliver palliative care education in response to the ongoing challenges and stressors created by the COVID-19 pandemic. Together, they can build resilience in frontline nurses and ultimately impact delivery of compassionate and empathetic care to patients.
Introduction
The COVID-19 pandemic created the greatest global health crisis of this century and surged relentlessly throughout the world.[1,2] Novel and intolerable pressures have been placed upon health care systems and workers during the crises affecting their capacity to effectively and safely care for patients.[3,4] Nurses are educated to deliver patient- and family-centered holistic care within their health care settings and rely on clinical empathy to understand and meet the needs of their patients and families. Although national organizations such as the Hospice and Palliative Nurses Association, American Organization for Nursing Leadership, American Nurses Association, American Association of Critical Care Nurses, and American Association of Nurse Practitioners have quickly recognized the undue stress nurses are under as they deliver care in the midst of the pandemic, the impact on nurses' clinical empathy is not fully understood. This article aims to explore nurse perceptions of how caring for patients with COVID-19 has impacted the delivery of nursing care, affected their clinical empathy, and resulted in utilization of key resilience strategies to effectively cope. Recommendations will be provided for nurse clinicians to advocate for themselves in situations that require maximum empathetic reserve and to help health care organizations and nurse leaders identify strategies to best support their staff while navigating through the pandemic.
Clinical empathy is described as a specific form of empathy that has therapeutic impact in the medical setting, allowing for increased capacity by caregivers to understand a patient's lived experience and situation.[3,5] When empathy is present, health care professionals have higher morale, provide safer care, and promote patient satisfaction by understanding their suffering and pain.[5–7] It is imperative that caregivers have self-awareness of their emotional response to others' distress and suffering to act responsively with compassion and avoid becoming overwhelmed or consumed by compassion fatigue.[6,8,9] Riess[5] (p76) asserts that "empathy cannot exist without compassion, as they are part of the same response continuum that moves human beings from observation to action."
The pandemic has placed a severe strain on the ability of caregivers to provide care to patients in the usual manner because of increased workload demands, staffing shortages, deficits of personal protective equipment (PPE), and the severity of the COVID-19 illness.[10–13] Studies have examined the experiences of frontline workers during the pandemic and describe challenges including the inability to provide a human comforting connection, unfamiliarity with the environment, disease, ongoing changes in practice guidelines, and witness to extraordinary patient suffering and death.[3,4,6,14,15] This has resulted in the substitution of clinical empathy by a sense of duty to provide care to patients, putting nurses at a high risk for physical and emotional distress.[3,4] The distress can be manifested by emotional/physical exhaustion, depersonalization, cynicism, and a sense of decreased personal/professional accomplishment.[12,16–18] As these factors build during daily exposure to the high-stress environment, it can lead to decreased quality of patient care, decreased patient satisfaction, and increased medical errors.[16]
The aim of this exploratory study was to determine the impact of the COVID-19 pandemic on nursing care delivery, the empathetic response of nurses to their patients and family members, and the emotional and physical well-being of the nurses. A convenience sample of 4 frontline nurses were interviewed while in the midst of the pandemic. Although content is not generalizable to large populations, lessons can be learned from their experiences with stories that highlight the valuable contribution nurses bring to their workplace. Themes will be drawn from these narratives highlighting the impact on care delivery and emotional responses of the nurses.
Journal of Hospice and Palliative Nursing. 2022;24(2):132-139. © 2022 Lippincott Williams & Wilkins
