Alone in the Living Room: How Swiss Home Care Nurses Endured Four Waves of COVID-19

When the first wave of the COVID-19 pandemic swept through Switzerland in the spring of 2020, most of the world’s attention fixed on overwhelmed hospital wards and intensive care units. But a quieter, lonelier drama was unfolding in private apartments across the canton of Geneva. There, home care nurses continued to cross the threshold of vulnerable patients’ homes every day, often without adequate protective equipment, clear protocols, or the reassurance of colleagues at their side. A new descriptive phenomenological study published in the journal Heliyon has now documented, in unprecedented detail, how these nurses lived through the first four waves of the pandemic, revealing an experience defined by fear and exhaustion but also by unexpected professional growth and a renewed sense of purpose.

The research team, led by Katia Iglesias of the Geneva home care institution imad, interviewed twelve nurses who had originally enrolled in a randomised controlled trial designed to promote advance care planning among patients receiving early palliative care at home. That trial, launched in January 2020, was suspended almost immediately because face-to-face meetings with frail patients became impossible under public health restrictions. Rather than abandon the project entirely, the researchers pivoted, expanding their interview guide to capture the nurses’ lived experiences of practising home care during the crisis. Between November 2021 and February 2022, eleven interviews were conducted by videoconference and one in person, each lasting an average of fifty-two minutes, and all were transcribed verbatim and analysed using the five-stage descriptive phenomenological method of Giorgi and colleagues.

The participants, eleven women and one man aged between 33 and 54, brought between four and twenty-four years of professional experience to their accounts. Their neighbourhoods spanned low, medium and high socio-economic districts of Geneva, and most worked at eighty percent of full-time hours. Because all had prior exposure to training on advance directives and a communication tool called the Go Wish card game, the researchers could also examine how the pandemic shaped their engagement with end-of-life conversations, a dimension of nursing work that the crisis made simultaneously more urgent and more difficult.

The analysis identified six interrelated themes, and the first is perhaps the most visceral: confronting a changing and uncertain reality. The nurses described the first wave as an entirely novel situation devoid of clear guidelines, built on fragmentary scientific knowledge, in which directives changed so rapidly that instability became the only constant. They adopted pragmatic, adaptive postures guided by immediate needs and practical judgment while waiting for clearer instructions, yet patients looked to them for answers they could not provide. Fear emerged as the dominant emotion, taking multiple forms: fear of infection, of transmitting the virus to patients or to loved ones at home, and of making professional mistakes. As the months accumulated, sadness at the loss of spontaneity in professional relationships and anger at the crisis’s duration and mounting demands surfaced alongside it.

Institutional responses played an ambivalent role in this emotional landscape. Formalised communication through newsletters, written protocols and email instructions became a reassuring point of reference, counterbalancing the contradictory messages circulating in the media. Health measures such as mask wearing, physical distancing and the suspension of face-to-face meetings were sometimes experienced as burdensome, but they also restored a degree of predictability. The institution facilitated childcare, temporary hotel accommodation, additional days off and simplified border crossings for cross-border workers, and created specialised teams to care for COVID-positive patients. Yet access to essential protective equipment remained insufficient during the first waves, generating frustration and anxiety, and promised reinforcements often proved poorly adapted to the realities of home care, where chronic staff shortages and pandemic-related absences pushed workloads to breaking point.

To survive this prolonged strain, the nurses developed a repertoire of coping strategies. Individually, they put situations into context, relativised difficulties, filtered their media exposure and established restorative routines, from leisure activities to time in nature, sometimes achieving a form of emotional habituation that allowed them to live with the virus. Collectively, mutual support among colleagues proved to be the single most important source of resilience, particularly in the early stages. But the study documents how this fragile equilibrium eroded: health restrictions curtailed informal interaction, team meetings were suspended, and the loss of collective connection became a factor of psychological fragility, deepening the isolation inherent in working alone in patients’ homes.

The pandemic also transformed care itself. Directives from the first wave onwards reduced the number and duration of home visits, and non-urgent interventions such as hygiene care were spaced out, shortened or temporarily suspended. Nurses compensated with telephone follow-ups and by remaining physically present despite personal risk. Some found that even brief interactions acquired a more human, egalitarian quality, reflecting the shared experience of the crisis, and for socially isolated patients the nurse became the only remaining link to the outside world. Dedicated Covid home teams relieved pressure on regular staff, but raised questions about continuity of the therapeutic relationship and the boundaries of professional roles.

Perhaps the most striking finding concerns professional identity, which the crisis simultaneously strengthened and eroded. On one side, navigating successive waves fostered expertise, empowerment and unprecedented social recognition: patients turned to nurses for guidance beyond their traditional scope, and society briefly rediscovered the centrality of care. Several participants expressed pride at seeing their profession valued in its most human, relational dimension. On the other side, accounts of physical and emotional exhaustion exceeding ordinary workload, moral depletion and gradual disengagement reveal a crisis of identity, an oscillation between vocation and discouragement that the repetition of waves and chronic uncertainty only deepened.

The sixth theme, engagement with end-of-life discussions and advance care planning, proved especially revealing. For some nurses, emotional overload and shifting priorities relegated these conversations to the background, or the memory of their training simply faded amid the turbulence. For others, the pandemic acted as a catalyst: confronting fragility of life daily made discussions about wishes, values and fears more tangible and legitimate. The Go Wish card game was described as a powerful relational aid, easing the emotional weight of these exchanges, and some nurses developed confidence even without formal tools. Yet implementation was frequently interrupted by ineligible patients, language barriers, lack of time and, crucially, a gap between acquired competence and institutional authorisation: no formal recognition, no possibility of billing such interventions, and systematic delegation of these discussions to palliative care teams. Some participants even carried the reflection into their private lives, initiating conversations about end-of-life wishes with their own families, where taboos and fear of intrusiveness proved harder to overcome than in professional settings.

The authors are careful to note the study’s limitations: the retrospective design means the accounts are reconstructed narratives rather than longitudinal observations, the sample excluded nurses who had left the service, and one interviewer’s prior involvement in the training may have shaped some responses despite safeguards against social desirability bias. Still, the findings carry a clear message that extends well beyond the pandemic. Training alone is insufficient; without clear role definitions, time allocation, documentation and formal recognition, relational competencies remain underused and vulnerable to being displaced by urgent clinical demands. As ageing populations increase the complexity of community-based care, the Geneva nurses’ experience suggests that health systems must build organisational structures that recognise both the technical and the deeply human dimensions of home care nursing, before the next crisis tests them again.

Subject of Research: Lived experiences of home care nurses during the COVID-19 pandemic in Switzerland

Article Title: Lived experiences of home care nurses during the COVID-19 pandemic in Switzerland: A descriptive phenomenological study

Article References: Iglesias, K., Verga, M.-E., Baptista Peixoto Befecadu, F., Kipfer, S., Pautex, S., Busnel, C., Séchaud, L., & Jaquier, V. (2026). Lived experiences of home care nurses during the COVID-19 pandemic in Switzerland: A descriptive phenomenological study. Heliyon, 12(15), Article e45503. https://doi.org/10.1016/j.heliyon.2026.e45503

Image Credits: AI Generated

DOI: 10.1016/j.heliyon.2026.e45503

Keywords: home care nursing, COVID-19 pandemic, Switzerland, Geneva, phenomenology, qualitative research, professional identity, advance care planning, end-of-life care, nurse burnout, coping strategies, healthcare workforce