Table 3 Representative quotes illustrating key themes

Emergence of new technologies

The phone calls were one of the most stressful things…Trying to reassure them, without actually knowing anything… There was not any reassurance I felt I had to give… I think there was a lot of anxiety just around phone calls and communication

We were also able to find alternatives, that is to say give online meetings and that was really a way for us to be able to at least give something

It put a huge barrier on communication

At worst it was anxiety provoking for families to see the person. A first visit to ITU seeing all that is destabilising, so on the screen … oh dear… with interference because the networks are rubbish. You didn’t hear well …. It was stressful

The majority of people didn’t have passwords and trying to get people to explain it to you, to show it to you. They are busy

The initiative of tablets appeared, to make video calls with families, which as an initiative can be super-good and was very necessary, but at the level of workload, it was often incompatible… there were no hands or people to dedicate the time to it

Relationships and Rapport Establishment

The family brought the patient to life for us

It meant much more wear and tear to care for patients, no longer at the level of techniques or things, but at the ‘human’ level

No family, no relatives and everything so it was often the nursing teams who had to make up for this deficit when we went to zero visits

We went from being totally holistic and patient-centred to just very task oriented

FP: There was also a feeling of disconnect from reality for the families

The volunteer service… was really helpful, where people were able to drop the things off, and then the volunteers were bringing them up. That felt like a really big step, even being able to have a few personal items from home.”

Flexibility of schedules was something that could be allowed more

Communication Challenges

It is not the same to talk on the phone than to talk in the face-to-face situation... I think especially the proximity, the flexibility and the face-to-face situation.. it always makes it more human

It helps us to know what the patient was like before … We learn things… Medications, treatments, their way of life ….. how independent they are … All that

You had to really make an over effort to explain things in great detail so that they could get an idea, and explain the steps, and without creating like too much hope… It is difficult to make the family understand what is happening without them being present.”

I felt there was a total lack of understanding on the phone, and that I couldn’t help the families at all, on the phone

Someone on the team has to dedicate themselves to family. Knowing that they can’t get in or out in any way, that they can’t take off their robes in any way

Doing some, almost simulation training, of communication over video

End-of-Life Care

I actually found the end-of-life stuff the hardest…I think, there are just so many different situations, where we weren’t allowed to let families in… I think the emotional burden of that was massive

But it was a shock from 24 h a day to 0 and after, except for the people who were dying …. No, not at all, no ……they died alone …yes, they were alone

Only having visitors at the end of life made me think a bit differently about decisions to change the focus of care to palliation. I felt I had to make sure I got it 100% right. There was only going to be one chance, they definitely had to be dying. They were only going to be allowed to visit once. If they didn’t die in that visit then they weren’t allowed back in because they were isolating.”

I sometimes had to arrange video and phone calls at the same time, they all wanted to say goodbye. I would bring the phone to the patient’s ear. It was not easy. Patients would not be able to speak, so we have to translate, in our own words. The most difficult is finding the right words

I once have a doctor whispering to me: ‘I told them they could all come in, the 4 of them’. I just said minutes before, that they could only come 2 by 2, we couldn’t have more at the same time, given the organisation of the ward. As a consequence, we are not credible. Yes, that is another consequence of having mixed, blurred messages: the lack of credibility

The restrictions, they were much longer in the other departments and much more draconian