The post-pandemic working experiences of hospice care staff

I'm Hope and I have just completed an undergraduate psychology degree. For my dissertation research project, I conducted an interpretative phenomenological analysis to explore hospice care staff's experiences of working in hospice care in the post-Covid-19 pandemic period. I have recently received a runner-up prize for the BPS West Midlands Undergraduate Award; I was nominated for the award by the psychology department at my university in recognition of my approach to and the outcome of my dissertation research project. 

The inspiration

I work as a healthcare assistant at a local hospice; my personal experience in this area drove my initial motivation to study hospice care. After exploring wider literature around hospice care, I developed a greater understanding of the topic from multiple perspectives and began to identify knowledge gaps in existing literature; this solidified my desire to study hospice care and facilitated a particular interest in exploring the experiences of hospice care staff. 

Existing literature

Existing literature in the area demonstrated how working in hospice care can be emotionally demanding because of frequent exposure to challenging and complex situations, such as illness, death and grief. Existing literature also suggested that the emotional demands associated with working in hospice care are increased during public health emergencies because of the additional strains placed on healthcare services, such as during the Covid-19 global pandemic. 

Although Covid-19 is no longer considered a global health emergency, many healthcare settings have experienced direct and indirect long-term effects of the virus and, as a result, a concern about how Covid-19 still impacts individuals working in healthcare has been highlighted. 

In addition, literature exploring the working experiences of healthcare staff during and following previous public health emergencies showed how their health and wellbeing were negatively affected well beyond the emergencies themselves. Despite all of this, there was a knowledge gap in existing literature, as the working experiences of hospice care staff after the Covid-19 pandemic had not been studied. 

Existing literature also indicated that the quality of care a patient receives is affected by the physical, psychological and emotional state of the individual providing their care. Thus, ensuring staff receive appropriate support to ensure patients experience an optimum quality of care furthered the rationale for wanting to understand how hospice care staff experience work following the pandemic. 

My research project

I chose to adopt a qualitative approach and to conduct an interpretative phenomenological analysis because I felt it would provide a more in-depth and contextualised account of hospice care staff's experiences and thus enable a more rich and nuanced understanding of how hospice care staff experience work in the post-pandemic period and the meanings that they ascribe to these. 

Six participants were recruited; all participants worked on the frontline in patient-facing roles and either provided hospice care to patients in inpatient units or the community. Individual semi-structured interviews were conducted with each participant.  

As a novice researcher with no prior experience in conducting interviews, I was initially nervous about the interview process and keen to ensure I allowed participants to effectively share their experiences. However, conducting a pilot interview helped me to familiarise myself with the process, reducing my initial anxiety and, with each interview, I became more confident in the process and more skilled in my approach. I did experience difficulty in getting some participants to discuss their experiences more openly than others, which is perhaps something I would further overcome with more experience. 

Findings

Following analysis, I identified six group experiential themes: feeling like the forgotten ones; being uncomfortable with post-pandemic restrictions; developing a new team identity; realising the pandemic wasn't all bad; discovering the pandemic's legacies; and wondering what the future holds. 

For participants, the overarching meanings of these post-pandemic working experiences were the results of hospice care having a delayed return to normal. So, although Covid-19 was having a declining influence on wider society, it was having an enduring influence on hospice care, and the results of hospice care then settling into a new normal, whereby it is no longer directly affected by the virus but will never return to how it was before the pandemic because Covid-19 is now part of society's backdrop.

I chose to present the later three themes for discussion in my report because I deemed them particularly salient to the research question and aims, as they were identified as participants' current post-pandemic working experiences, and they were deemed especially relevant for hospice care staff going forward. 

First, I discussed how, now that hospice care is not directly affected by Covid-19, participants are realising the pandemic wasn't all bad because they are seeing how, with hindsight, the Covid-19 pandemic positively impacted their work in some ways, which they no longer experience. In particular, participants felt there was a better staff-to-patient ratio, a more united group and less time pressure during the pandemic.

Second, I discussed how, now that Covid-19 does not directly affect hospice care, participants are discovering the pandemic's legacies as they are discovering things that have been left behind as a result of Covid-19 and how these are influencing their work in hospice care.  

To illustrate, participants discussed Covid's useful reminders; for example, participants felt the pandemic reinforced the importance of hygiene and maintaining good hygiene practices, and they talked about how they planned to continue these going forward. 

Third, I discussed how, now that hospice care is not experiencing direct effects of Covid-19, participants are wondering what the future holds because they feel hospice care's future, and its relationship with Covid-19 moving forward, is unclear. 

Therefore, for participants, realising the pandemic wasn't all bad, discovering the pandemic's legacies and wondering what the future holds meant hospice care is settling into a new normal.

Reflection

Since completing my dissertation research project, I have noticed examples of the identified themes when at work and feel I am more aware of the long-term influence of Covid-19. For example, discovering the pandemic's legacies can still be seen in mask-wearing to prevent the spread of flu, a precaution popularised because of the increase in mask-wearing during the Covid-19 pandemic.