A Comparative Study of End-of-Life Care Before and During the COVID-19 Pandemic Using Electronic Nursing Records

This study aimed to identify the end-of-life care provided to patients admitted to a ward using electronic nursing records standardized with SNOMED CT (Systematized Nomenclature of Medicine Clinical Terms) and to analyze changes in end-of-life care before and during the COVID-19 pandemic. The study setting was oncology or hematology-oncology wards in a tertiary care hospital. A total of 161 069 nursing statements for 600 patients before COVID-19, admitted from January 2018 to December 2019, and 110 333 nursing statements for 454 patients during COVID-19, admitted from January 2020 to December 2021, were extracted from the clinical data warehouse of the study hospital. We mapped 427 unique nursing statements to SNOMED CT. The differences in the number of SNOMED CT concepts among the three groups-patients before COVID-19, patients without COVID-19 during COVID-19, and patients with COVID-19 during COVID-19-were analyzed using analysis of variance. "Acute pain," "Patient on oxygen," "Notification of physician," "Oxygenation monitoring," and "Pain assessment" were recorded most frequently. The frequency of nursing statements related to oxygenation was significantly lower in patients without COVID-19 during the COVID-19 pandemic compared with patients before COVID-19. Nursing statements pertaining to emotional or spiritual care appeared to be underrepresented in both the nursing assessment/outcome and nursing intervention domains. Our study showed that the standardized nursing records can be used as a source of information to explore changes in end-of-life care before and during the COVID-19 pandemic.