A Qualitative Study of Nursing Practitioners’ Experiences on Dying Alone Due to COVID-19 in Greece

Background: Dying in isolation and without saying a goodbye before, during and after death causes patients, families and health providers to suffer greatly. In Greece, there is still limited knowledge about dying in isolation as perceived by frontline nursing practitioners working in a COVID-19 ward or ICU. Nursing practitioners spend a lot of time near their patients. Greece is most vulnerable country to the international problem of dying in isolation during the COVID-19 pandemic. Methods: A prospective qualitative study using in-depth interviews with fifteen frontline nursing practitioners working in a COVID-19 ward or ICU was conducted from July 2021 through December 2021. We performed a thematic analysis of the data. Results: Dying in isolation without saying a goodbye before, during or after death emerged as an extremely inhuman experience that critically ill covid patients and their loved ones had to go through. Fear of spreading COVID-19 infection, fear of liability, and fear of hindering the performance of nursing duties were emerged as main reasons behind strict visitation restrictions. Patients and family members were reported to have expressed very strong desire to communicate and interact with each other. Most participants were shown to be with high levels of empathy, willingness to provide holistic care. Furthermore, most participants were shown to be with high levels of psychological and moral distress. All participants held that visitations should be allowed on an individual basis, and remote communication technology should be available to any covid patient. Importantly, it was identified in this study that physicians’ and nursing practitioners’ discretion and goodwill can significantly mitigate the problem of dying alone. In some COVID-19 health care settings visitations were allowed at physicians’ discretion. These “clandestine” visitations were mentioned as practices that existed in reality, even though they were not officially recognized by the Greek rules. Furthermore, the quality of nursing care seemed to have shifted towards a broader definition. Political neglect was a factor that emerged as a major factor that enlarges the problem of dying in isolation. Finally, and most importantly, a shift towards a less patient-centered model of care was emerged from the data analysis. Conclusion: The results reinforce the existing literature on many fronts. However, we identified some nuances that are of great importance in planning tailored interventions to mitigate the problems related to dying in isolation from COVID-19, and most importantly, hold down the commonly accepted patient-centered model of care. On the account of the patient-centered model of care and the modern (broad, positive-holistic) concept of health, providing holistic care for critically ill covid patients is both an institutional duty and a moral obligation.