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P-205 Struggling for agency and morality in the face of repeated moral injury amongst palliative care nurses working during the COVID-19 pandemic: A narrative study
  1. Anna Lloyd1,
  2. Julie Young1,2 and
  3. Erna Haraldsdottir2
  1. 1St Columba’s Hospice, Edinburgh, UK
  2. 2Queen Margaret University, Edinburgh, UK


Background Palliative care nurses have been required to adopt physical distancing measures and the increased use of personal protective equipment impacting face-to-face communication with patients and relatives and to severely restrict visiting during the COVID-19 pandemic. What is unclear is how nurses managed and coped, over the time frame, with the resulting moral distress and moral injury.

Methods This study explored the changing personal and professional experiences of, and responses to delivering nursing care in a palliative care unit, under the imposed pandemic restrictions, through narratives. In-depth narrative focused interviews were undertaken. Interviews were transcribed verbatim and analysed using a narrative approach to consider the shape as well as content of the individual accounts given and to elucidate common themes.

Results Thirteen palliative care nurses who were working in a hospice in-patient unit in the UK before and during the pandemic were recruited. Moral distress and injury was evident in all the accounts with narratives suggesting three different responses occurred. These were acceptance, resistance and defiance and defeat. How nurses were able to reconcile themselves and their sense of morality to the experiences underpinned the narratives. Nurses struggled with not being able to care for patients and their families in a way that they were used to and that felt intuitive and many described personal as well as professional affront.

Conclusions Restrictions had a considerable impact on palliative care nurses at a professional and personal level in their ability to communicate with and provide care for patients and their families which led to moral distress and injury. How they managed this and made sense of what happened affected their capacity to cope, with those unable to reconcile their experiences being profoundly impacted and losing hope for the future.

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