The coronavirus disease (COVID-19) is challenging heath systems in Australia and internationally. Intensive care unit (ICU) teams are responsible for managing the care of critically ill patients, whilst ensuring stringent infection prevention and control (IPC) measures minimise risk of transmission of COVID-19 including restricting access to the ICU. Significant media attention has highlighted the plight of families who are unable to say goodbye to patients dying of COVID-19 in the ICU, contributing to family distress and complicated grief.
To develop a position statement to provide critical care nurses with specific practice recommendations for facilitating next-of-kin presence for dying patients in ICU.
A search for evidence related to family visitation, family presence at the end of life, and end-of-life care in critical care was undertaken. Where possible, Australian research evidence was selected to ensure relevance to Australian intensive care settings. Given the unprecedented nature of the COVID-19 and consequent lack of time for publication of high-quality research, other guidelines, opinion pieces and media reports related to COVID-19 were also used to inform this position statement.
The Position Statement provides eleven specific practice recommendations commencing with when and how next-of-kin visits should occur, steps to guide the visit and use of personal protective equipment, hygiene and travel recommendations and the importance of emotional support for next-of-kin. The Position Statement demonstrates that it is possible to facilitate a safe visit for next-of-kin for patients dying from COVID-19, where intensive care staffing and resources permit.
Having courage to be creative in addressing end-of-life challenges, rather than adopting a purely risk-averse approach, such as that created by COVID-19 is key to producing a solution that addresses barriers to end-of-life care provision for the dying patient and their family. Given that dying is not only what the patient experiences, but also what the family experiences, this position statement is key to guiding intensive care nurses in the provision of compassionate family-centred care.
Conflict of interest