Nurses' Experiences of Serious Illness Conversations with Marginalized Patients in COVID-19.

Context: Nurses' professional training and experiences uniquely equip them to engage in serious illness conversations (SICs), however, their experiences conducting SICs with patients from historically marginalized groups during the COIVD-pandemic remain understudied.

Objectives: To understand nurses' experiences in conducting SICs during the COVID-19 pandemic with patients and family members from marginalized groups.

Methods: We conducted a mixed-methods study at two academic medical centers from April 2022 to June 2022. Participants included 20 registered nurses or nurse practitioners who received training using the Serious Illness Conversation Guide and conducted SICs during the pandemic. Surveys completed included demographics, Advance Care Planning Self-Efficacy Scale, and Moral Distress Thermometer. Virtual focus groups were conducted by a trained researcher using a guide. Survey and qualitative data were integrated to derive themes that captured nurses' experiences conducting SICs during the pandemic.

Results: Nurses reported high self-efficacy and moderate levels of moral distress. We identified five key themes influencing nurses' experiences in engaging with marginalized patients in SICs: relational skills, pandemic-related challenges, exacerbation of moral distress and burnout, patients' unmet health-related social needs, and strategies to mitigate these challenges. Integration of survey and focus group data elucidated how highly trained nurses encountered challenges in conducting SICs despite high self-efficacy and how they experienced moral distress due to the uniquely challenging context of the pandemic and the structural barriers faced by marginalized patients.

Conclusions: These findings highlight the need to address patient health-related social needs, support nurses to conduct conversations, and promote an environment that supports nurses' well-being.