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      A qualitative study of nursing practitioners' experiences with COVID-19 patients dying alone in Greece

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          Abstract

          Background

          In Greece, there is still limited research on death in isolation due to COVID-19. This deserves attention because of the recent financial crisis, which profoundly impacted public health, and the high relevance of the Hippocratic tradition to the moral values of clinical practice.

          Methods

          A prospective qualitative study using in-depth interviews with 15 frontline nursing practitioners working in a COVID-19 ward or intensive care unit (ICU) was conducted from July 2021 to December 2021.

          Results

          The inability of family members to say a final goodbye before, during, or after death by performing proper mourning rituals is extremely inhuman and profoundly impacts the mental health status of patients, family members, and nursing practitioners. Patients and their family members strongly desire to see each other. Epidemiology, liability, and proper nursing performance emerged as reasons for the enforced strict visitation restrictions. Participants emphasized that visitations should be allowed on an individual basis and highlighted the need for the effective use of remote communication technology, which, however, does not substitute for in-person contact. Importantly, physicians allowed “clandestine” visits on an individual basis. Nursing practitioners had a strong empathic attitude toward both patients and their families, and a strong willingness to provide holistic care and pay respect to dead bodies. However, they also experienced moral distress. Witnessing heartbreaking scenes with patients and/or their families causes nursing practitioners to experience intense psychological distress, which affects their family life rather than nursing performance. Ultimately, there was a shift from a patient-centered care model to a population-centered care model. Furthermore, we identified a range of policy- and culture-related factors that exaggerate the negative consequences of dying alone of COVID-19.

          Conclusion

          These results reinforce the existing literature on several fronts. However, we identified some nuances related to political decisions and, most importantly, convictions that are deeply rooted in Greek culture. These findings are of great importance in planning tailored interventions to mitigate the problem of interest and have implications for other similar national contexts.

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          Most cited references74

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          Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis

          Highlights • At least one in five healthcare professionals report symptoms of depression and anxiety. • Almost four in 10 healthcare workers experience sleeping difficulties and/or insomnia. • Rates of anxiety and depression were higher for female healthcare workers and nursing staff. • Milder mood symptoms are common and screening should aim to identify mild and sub-threshold syndromes.
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            Job burnout.

            Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job, and is defined by the three dimensions of exhaustion, cynicism, and inefficacy. The past 25 years of research has established the complexity of the construct, and places the individual stress experience within a larger organizational context of people's relation to their work. Recently, the work on burnout has expanded internationally and has led to new conceptual models. The focus on engagement, the positive antithesis of burnout, promises to yield new perspectives on interventions to alleviate burnout. The social focus of burnout, the solid research basis concerning the syndrome, and its specific ties to the work domain make a distinct and valuable contribution to people's health and well-being.
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              A Qualitative Study on the Psychological Experience of Caregivers of COVID-19 Patients

              Highlights • Studies on the psychological experience of nurses combating COVID-19 are lacking • We investigated the psychological experience of caregivers of COVID-19 patients • Nurses showed interweaving positive/negative emotions during outbreak of COVID-19 • Negative emotions are dominant in the early stages of the COVID-19 outbreak • Coping styles and psychological growth are important for maintaining mental health
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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                21 October 2022
                2022
                21 October 2022
                : 10
                : 981780
                Affiliations
                [1] 1Laboratory of Forensic Medicine & Toxicology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki , Thessaloniki, Greece
                [2] 2Postgraduate Program on Bioethics, Laboratory of Bioethics and Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace , Alexandroupolis, Greece
                Author notes

                Edited by: Francesco Chirico, Catholic University of the Sacred Heart, Italy

                Reviewed by: Pietro Crescenzo, Italian Red Cross, Volunteer Military Corps, Italy; Sheryl Reimer-Kirkham, Trinity Western University, Canada

                *Correspondence: Polychronis Voultsos pvoultsos@ 123456auth.gr

                This article was submitted to Public Mental Health, a section of the journal Frontiers in Public Health

                Article
                10.3389/fpubh.2022.981780
                9634155
                36339201
                e91f4202-26ca-467c-b728-e285836ca315
                Copyright © 2022 Voultsos, Tsompanian, Deligianni, Tsamadou and Tsaroucha.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 19 August 2022
                : 10 October 2022
                Page count
                Figures: 0, Tables: 2, Equations: 0, References: 78, Pages: 17, Words: 14425
                Categories
                Public Health
                Original Research

                death in isolation,dying alone,hospitalized covid-19 patients,covid-19 pandemic,nursing practitioners/professionals

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