A personal reflection on grief during the pandemic

Submitted by Kassey M. June 2021, reflecting on her grief while working in Long Term Care during COVID

Grief is an understandable reaction to loss. It’s the emotional pain you experience when something or someone you care about is taken away from you. It can be excruciatingly painful at times. From shock or fury to disbelief, remorse, and deep grief, I experience a wide range of uncomfortable and unexpected feelings. Grief is a total whole person experience, and may have a negative impact on physical health, making it difficult to sleep, eat, or even think clearly. These are common reactions to loss, and the greater the loss, the greater the grief. 

Personally, my most profound experience with grief was during my time working at a retirement home in the heart of the pandemic.

Personally, my most profound experience with grief was during my time working at a retirement home in the heart of the pandemic. I was approached right before our home was hit with its first case to come work at the front desk. I was warned that things would be more intense than the work I was doing previously, but I was up for the challenge. Immediately I was hit with a whole different perspective that I did not get to see working in dietary. Besides working with management and staff, I experienced constant losses as I cared for residents. 

I grew closest to the residents that had severe dementia on the second floor of the building. They loved my company and conversation. Making them smile and laugh brought them joy and allowed them to feel like they had loved ones around them. It made me feel attached and I would imagine caring for my own grandmother. Knowing that many of them did not have family visit, I felt proud that they remembered who I was and became excited when I arrived. Knowing this…was what really broke me when working through the pandemic.  

Our first deaths were those with severe dementia, then other residents who I had newly become acquainted with. Having to hear the news at almost every shift that someone else had passed and watching the residents deal with the loss of their friends and loved ones was difficult.  

There was no room to show any signs of emotion because they were so broken. Having to bottle these things in (still to this day) was debilitating. Having to speak to family members grieving over the deaths became numbing because again, you had to be strong. Knowing that there was nothing I could do to take away the pain from the residents and families made me feel almost like I was at fault. I could only offer my words and time to help them forget the world around them, even if for only a few moments.  

These feelings eventually caught up to me and I realized I was burned out. I was extremely emotional on some days, then snapped into feeling numb and emotionless. The grief felt like waves crashing down and flowing rapidly at all times. My emotions were about to burst and overflow at the drop of a hat. There were many moments at work that they did.  

I wish there was more help for staff who have to suffer through this grief. When I reached out for help there was nobody there to listen or allow me to process what was happening. Why? Maybe because we were all dealing with this and because we all felt like we were drowning. 

Grief doesn’t always get better with time; I am learning to function with it and it surprises me less often. I am forced to cope and adapt. It affects me in all aspects of my life. I have learned to seek help, and have learned how important mental health and selfcare is to cope with the grief. Recognizing and processing how I am feeling is the first step to getting better. 

Submitted by Kassey M

WEBINAR FOR PSWs  Addressing our Grief associated with COVID  

Register for September 1st, FREE WEBINARS FOR PSWs, Fatigue, Burnout and Resilience

Palliative Care – a Human Right – so apparent during COVID

Deaths from COVID-19 are approaching 3 million world-wide. Much of the discussion about ethical issues has centered around the availability of ventilators, but little has been said about the need and the responsibility to provide palliative care, ways to integrate a palliative approach for those who are seriously ill, and how to best support those who may or many not get (or want) a ventilator.

In Ontario palliative care specialists helped and provided care in the long term care facilities hardest hit by COVID. But specialist cannot do this in isolation.

In the Journal American Medical Association, article titled, “Integration of Palliative Care into All Serious Illness Care as a Human Right” Rosa, Ferrell and Mason wrote:

“COVID-19 has highlighted that every clinician needs knowledge and skills in the fundamentals of palliative care.“

Palliative care is not dependent on life-saving interventions. It may very well include a ventilator, but it is ultimately structured around the individualized wants and needs of the patient. It includes alleviating suffering and managing complex communications, psychosocial dynamics, fluctuating symptom management needs, and spiritual care throughout the dying process.

Every patient treated with a ventilator also needs palliative care. It is not an either-or clinical proposition, but rather a both-and moral imperative.

COVID-19 has accentuated the need for clinicians to have frequent conversations with patients and families about dying. The pandemic has forced many healthy people to confront rapid-onset, life-threatening trajectories of acute illness. Patients are dying without their loved ones, and families are grieving alone. For every person who dies, an average of 9 others are profoundly affected and grieve.2 COVID-19 has interrupted the cultural and community practices for coping with death, raising concerns about the pervasiveness of grief and loss associated with the pandemic…. 

Access to palliative care is a human right. Our inability to deliver it in the setting of COVID-19 and other serious illnesses is a human rights violation. Education… is needed now.

Personal Support Workers and nurses (both in field and in training), like all health care providers, need the tools and foundation to know how to support individuals living and dying with COVID-19 or living and dying with any life-limiting illness. Now.

Providing Care During COVID

On Monday, Dr David Kenneth Wright spoke during the “FREE WEBINAR SERIES for PSWs about providing care during COVID. I was touched by the stories he shared, by the points that he made, and by the responses/input from those who attended.

Near the end of his presentation he said and asked, “COVID-19 has changed so much in the world, but what should it NOT change?” Participants responded:

  • Love and respect for each other
  • Our level of empathy and kindness
  • Compassion and care
  • Care providers dignity and respect

I am inspired by their spontaneous thoughts. I agree, that DURING COVID we should KEEP our compassion, care and concern.

Then I reflected on the things that changed during COVID that I WANT TO KEEP AFTER COVID. The first two that come to mind are:

  • Doctor appointments online
  • A slower, gentler calendar

Then I reflected on the things that I can’t wait to change after COVID. My first three thoughts are:

  • Hugs – giving hugs, long hugs, group hugs, strangle hold hugs, happy hugs, sad hugs… hugs with people I know and hugs with strangers
  • Seeing, being with, hugging and holding grandkids!
  • Gatherings with more than our bubble – in fact, a bubble bath of bubbles and friends, a dance with CCR, and a pot luck feast.

What are the things that you want to keep now, during COVID? What are the things that you want to keep AFTER COVID? What are the things that you can’t wait to change?

Have a great day!

Remembering Strategies for Safe Opioid Use

safe opioid use in the midst of the opioid crisis

Managing pain and dyspnea for people with life limiting illnesses requires safe opioid use. Dyspnea is one of the most common symptom experienced by people with COVID-19, so this is a good time to review safe strategies for using opioids.

Opioid misuse can be minimized by using risk assessment tools, contracts for opioid use, and following guidelines for safe storage and disposal. The following are examples of tools you might see or use to support safe use.

Risk Assessment Tools

When a pain or dyspnea assessment indicates the need for opioids for symptom management, a risk assessment tool can be used to help to identify those people who are more likely to struggle or be struggling with addiction issues. Identifying these people before beginning opioids can help the health care team safely manage their opioid use.

Four standardized tools are available at the website http://Opioidrisk.com. The tools vary from a 1 minute self-report to a 5 minute interview tool, offering a range of ways to assess the risk of opioid misuse.

Tell us about the tools that you use in your location. How are they different? Please post into the comments section, if possible.

Contracts and Agreements for Safe Opioid Use

Part of process for initiating opioids could include the discussion and signing of a contract, clearly outlining the person’s responsibilities for safe opioid use, including storage and disposal of medications. The contract facilitates the discussion around safe opioid use and will help establish the parameters required for safe opioid use in the home.

What types of contracts or users agreements for opioid use are you familiar with? Are they used before beginning opioids? Please add your document/contract or link it into the comments here. It would be interesting to see what is used for ensuring safe opioid use in different locations in Canada and the USA.

Tell us your thoughts on this contract linked here. Which parts are helpful and which parts don’t you like?

Sample User Agreement

Guidelines for Prescribing Opioids for Chronic Pain

2017 Canadian Guidelines for Opioid Use for Chronic Pain

Opioids -How to Use Them Safely

Guidelines for Storage and Disposal

Completing a risk assessment and contract with the person receiving the opioids can help facilitate safe opioid use. Including the following key steps (from www.healthcareprovidersolutions.com) when handling opioids will help decrease the risk of misuse and diversion:

  • Counting controlled substances at each visit for each patient, regardless of the risk of diversion in their home.  This practice is helpful for many reasons not just identification of possible diversion but may help to identify diversion early.

  • Limiting the supply of controlled substances.  In situations where diversion is known or suspected, daily deliveries of the controlled substances needed by the patient may be made or limiting the supply to just a couple of days is implemented.

  • Limiting access to the controlled substances.  This may be in the form of a lock box in the patient’s home with only certain individuals and hospice staff having access.

  • Working with the patient and family to relocate the patient to a more controlled environment such as a nursing home or hospice inpatient unit.

Health care providers need to know how to safely dispose of opioids. The following are guidelines developed for health care providers in the USA for disposing of opioids. Check for specific policies and procedures at your location.

Resources for Safe Opioid Use by Health Care Professionals and Family

Institute for Safe Medication Practices Canada – Opioid Stewardship – Brochures and downloads available

Fraser Health: Principles of Opioid Management – with specifics of safe handling and disposal of fentanyl patches

Four Strategies for Managing Opioid Side Effects

Strategies for Harm Reduction

Implementing any of these strategies for harm reduction may be helpful in reducing the current opioid crisis. Consider how to respond to people experiencing addiction with compassion and to support them in their rights to equal health care.

Canadian Nurses Association – Harm Reduction

BC Nurses Union – Position Statement on Harm Reduction

Compassionate Care for People with Addictions

Update of blog originally published in 2017