' horizontal ellipsis you just put up with it for the sake of humanity.': an exploratory qualitative study on causes of stress in palliative care nursing during the COVID-19 pandemic in Germany

Objective To explore and analyse causes of stress among nurses in palliative and inpatient hospice care settings in Germany during the COVID-19 pandemic. Design Explorative, qualitative study using problem-centred interviews. Interview data were analysed using structured qualitative content analysis. Setting Telephone interviews with nurses of different settings of palliative and inpatient hospice care. Participants 16 nurses from inpatient hospice, palliative care units and specialised palliative home care were recruited. Results COVID-19 infection control measures placed both physical and psychological strain on palliative care nurses. Due to changes in infection control information, workflows were being readjusted on a daily basis, preventing everyday routines and hindering relief from stress. There are reduced and limited opportunities for sharing and reflecting on daily working routines with team colleagues. Specific causes of stress in the individual settings of palliative and inpatient hospice care were identified. Overall, there is a tension between the nurses' perceptions of proper palliative care nursing, in terms of closeness, psychosocial and emotional support and compliance with infection control measures. Conclusions Palliative care nurses have been exposed to high levels of both physical and psychological stress during the COVID-19 pandemic. This requires rapid relief and support, with a need to ensure continuity of professional supervision and peer-support, which may be facilitated via digital technologies. The unique role of nurses in inpatient hospice and palliative care during COVID-19 ought to be recognised and valorised.