“Being a round square in an extremely challenging situation”—Healthcare professionals’ experiences of palliative care during the COVID-19 pandemic – A deductive and inductive qualitative study

Background The COVID-19 pandemic has highlighted the importance of healthcare systems that can deliver high-quality palliative care during extreme challenges. During the pandemic, professionals across all healthcare contexts confronted enormous pressure due to a lack of pandemic readiness, practical and emotional challenges, and an increased number of dying patients. To support equitable high-quality palliative care for all people in future pandemics, it is crucial to learn from the nurses on the front lines during the COVID-19 pandemic. Aim To explore nurses’ experiences of providing end-of-life care in general and specialized palliative care settings to patients during the COVID-19 pandemic. Methods This qualitative study is part of a larger Swedish–Norwegian multi-center project called Palliative Quality Care COVID-19 (PaQC-C19). Data were collected in autumn 2021 and spring 2022 using qualitative individual interviews with 20 registered nurses and assistant nurses in general and specialized palliative care. A stepwise deductive and inductive qualitative content analysis was utilized in the search for domains and subthemes following the method of Elo and Kyngäs (2008). Results Three domains, one overarching theme, and nine subthemes were developed. The domains described positive and negative aspects as well as strategies used when providing modified palliative care, the challenges concerning contamination, and how the nurses experienced guidance from managers during the pandemic. The overarching theme “being a round square in an extremely challenging situation” summarizes how the nurses safeguarded the patients’ dignity and provided support to the next of kin in extremely challenging situations during the COVID-19 pandemic. Conclusions The results of this study suggest that the prerequisites for nurses and the palliative care approach they use change during a pandemic; they felt inadequate and insecure and struggled very hard throughout the seemingly never-ending pandemic. These findings can be used as a basis for reflection in collaborative learning interventions within palliative care and as a guide for teachers in educational palliative care programs.