{"id":18687,"date":"2020-05-11T16:57:22","date_gmt":"2020-05-11T21:57:22","guid":{"rendered":"http:\/\/thepapergown.zocdoc.com\/?p=18687"},"modified":"2023-03-06T11:12:14","modified_gmt":"2023-03-06T16:12:14","slug":"hospital-care-in-a-covid-world","status":"publish","type":"post","link":"https:\/\/www.zocdoc.com\/blog\/healthcare-trends\/hospital-care-in-a-covid-world\/","title":{"rendered":"How Are Hospital Patients Doing Without Visitors?"},"content":{"rendered":"

Before intubating her patient, Dr. Eliotte Hirshberg FaceTimed the woman\u2019s daughter. As another nurse stroked the patient\u2019s head, Hirshberg held her hand and, with the help of an interpreter, explained to the patient and her daughter what would happen next. After the call ended, the nurse administered anesthesia as Hirshberg prepared for the procedure, clutching the patient\u2019s hand the whole time.\u00a0<\/span><\/p>\n

\u201cWe always ‘lay hands on the patient\u2019; that’s part of being in the healthcare profession,\u201d says Hirshberg, associate director of the Center for Humanizing Critical Care at Intermountain Healthcare. \u201cWe put on the appropriate PPE [personal protective equipment], but we are always holding people’s hands.\u201d<\/span><\/p>\n

All sorts of healthcare practices and rules changed in response to the coronavirus outbreak. As doctor’s offices and clinics closed, the vast majority of nonurgent visits either went virtual or got pushed off. Many hospitals began prohibiting visitors except in extenuating circumstances, such as for final goodbyes or to lend extra support to patients with cognitive impairments. But healthcare workers are still making sure patients experience human connection, through <\/span>physical touch and communicating with loved ones.<\/p>\n

\u201c<\/strong>One of the challenges across the country is people don’t have an inside view of what’s going on in the hospitals,\u201d says Jade Flinn, nurse educator for the Biocontainment Unit at Johns Hopkins Hospital. \u201cWe are still delivering our best care, including hand-holding and wiping eye boogies so patients look their best, even though they can’t have visitors.\u201d<\/span><\/p>\n

All of this helps patients, as well as caregivers and healthcare providers, cope with the stress of a coronavirus hospital stay.\u00a0<\/span><\/p>\n

Loved ones help with recovery<\/h2>\n

Hospitalization can be inordinately difficult under any circumstance. \u201cBeing cut off from other aspects of human existence can be terrifying and stressful,\u201d says Cheryl Woods Giscombe, a professor of quality of life, health promotion and wellness at the University of North Carolina at Chapel Hill School of Nursing. \u201cThere’s more time to worry and focus on your symptoms.\u201d\u00a0<\/span><\/p>\n

Having support is critical for recovery, explains Hirshberg, who is also an associate professor of pediatric and adult critical care medicine at the University of Utah. The presence of family (or friends) can provide a sense of reassurance and familiarity to calm a patient’s anxiety, fear and loneliness. What\u2019s more, involvement can help improve treatment. Family members can share information about patients to humanize them, so that they become fathers, mothers, siblings and children, rather than just patients, in the eyes of healthcare providers. They can also advocate for patients, help orient them if they are in and out of consciousness, and <\/span>give the hospital staff insight into the patient’s support system<\/span><\/a>, which leads to <\/span>better physiological and psychological outcomes<\/span><\/a>.<\/span><\/p>\n

There isn’t much research on ICU patients, who are often unable to communicate during treatment. But some <\/span>studies<\/span><\/a> suggest that while patients prefer some restrictions on visitation, such as limiting visits to certain hours, they feel more supported when family members are present.<\/span><\/p>\n

Additionally, the simple act of having a loved one hold your hand can <\/span>reduce pain<\/span><\/a>. \u201cTouch calms the nervous system,\u201d explains Tiffany Field, director of the Touch Research Institute at the University of Miami School of Medicine. It triggers an increase in serotonin, \u201cthe body’s natural antidepressant and anti-pain neurotransmitter,\u201d Field says. \u201cThat helps the person relax, decreases anxiety, and lowers blood pressure and heart rate.\u201d<\/span><\/p>\n

Other research finds that massage can <\/span>enhance immune function<\/span><\/a>. \u201cIf you move the skin, it stimulates pressure receptors,\u201d Field explains. \u201cThese send messages to the brain to decrease the stress hormone cortisol and increase vagal activity, the production of natural killer cells and natural killer cell activity.\u201d These cells kill viral, bacterial and cancer cells, although the effects of massage on COVID-19 hasn’t been studied.<\/span><\/p>\n

You don’t need a massage to experience these benefits. \u201cYoga, walking on the floor, holding hands \u2014 anything that moves the skin stimulates the pressure receptors underneath the skin,\u201d Field says. Hugs may help too: In a <\/span>study published in <\/span>Psychological Science<\/span><\/i><\/a> in 2015, when participants were exposed to a cold virus, those who got more hugs <\/span>exhibited less severe symptoms.<\/span><\/p>\n

Different but the same<\/h2>\n

It\u2019s a concern that\u2019s come up repeatedly in coronavirus coverage:<\/span> What happens to a patient who doesn\u2019t get to see any familiar faces, or feel the loving squeeze of a hand they\u2019ve held before? Flinn recalls a man who was admitted for care and investigation of COVID in early March. His partner asked if anybody would be in the room to make sure the patient was comfortable. \u201cI will be there, and I will call you right after it’s done,\u201d Flinn told him.<\/span><\/p>\n

\u201cIt struck me,\u201d she says. \u201cI assume we [nurses] will always be there and that people assume that. But during the coronavirus, many assume their loved ones will be alone the whole time.\u201d\u00a0<\/span><\/p>\n

Instead, nurses and attendants work hard to make the experience feel less lonely: They hold patients\u2019 hands during procedures, bathe them, and turn their bodies to prevent bedsores. \u201cThat human touch has not gone away; we’re just wearing a greater level of protection,\u201d Flinn says. \u201cAnd we’re more cognizant that when we touch something, we need to wash our hands or change our gloves.\u201d<\/span><\/p>\n

This not only helps patients; Field says it can also help the nurses, since touch, even through layers of PPE, has a calming effect. \u201cThe person who gives the stimulation is getting the same kind of input to their skin,\u201d she explains.\u00a0<\/span><\/p>\n

Flinn says the physical contact makes a difference. \u201cI feel much more connected to patients when holding their hand during a procedure or wiping their eyes,\u201d she says. \u201cI find comfort in being able to provide that human side.\u201d<\/span><\/p>\n

To replace in-person visits, most hospitals are relying on virtual interactions. \u201cIn the interest of trying to champion community health and not contribute to the spread of COVID-19, we are sensitive to the difficulty of being isolated from loved ones, and we’ve tried to create other ways to involve family in the care as a team member,\u201d Hirshberg says. No matter the circumstances, nurses, pharmacists, respiratory therapists and physical therapists usually hold daily multidisciplinary rounds to discuss a patient’s status and make any changes to their care plan. Ordinarily,<\/span> they encourage a family member to be present for this. Right now, however, some hospitals are calling loved ones instead to keep them apprised of how patients are doing and give them the opportunity to ask questions.\u00a0<\/span><\/p>\n

Some hospitals also encourage patients to bring their phones with them so they can schedule calls or video chats with friends and family. Since the critically ill may not be able to talk, Hirshberg says nurses help schedule these calls to take place when patients are awake and alert. \u201cJust being able to visualize their family member may make a huge difference for both the patient and the family member,\u201d she says.<\/span><\/p>\n

For those who don’t have their phones, many hospitals have acquired tablets for patients to use. These video calls may also help with <\/span>ICU delirium<\/a>, a condition that can cause hallucinations, incoherent speech and aggression. \u201cHaving something familiar might be able to help reorient them,\u201d says Jennifer McAdam, associate professor of nursing at Samuel Merritt University.\u00a0<\/span><\/p>\n

It takes a team<\/h2>\n

Whether someone is in the ICU for COVID-19 or a different reason, nurses encourage family members to stay in touch with the care team \u2014 and to trust them.<\/span><\/p>\n

Ask how you can be an active part of a patient\u2019s care team, Woods Giscombe says. Learn the best way to stay in touch with your loved one; make sure their healthcare providers know your name and have two phone numbers to reach you. It’s frustrating to call a nurse and hear their voicemail, but don’t be discouraged. They\u2019re probably with a patient, and they\u2019ll do their best to get back to you. If they don\u2019t, call back. \u201cWe recognize this is stressful, and all of our staff is ready and willing to engage and talk with family members over the phone,\u201d Hirshberg says.\u00a0<\/span><\/p>\n

\u201cAs nurses and healthcare professionals, we didn’t go into this as just another job,\u201d Flinn adds. \u201cWe went into this because we want to be there to be helpful. It’s a calling and duty that we are fulfilling every day. Our care has not changed [because of the coronavirus]. We are still delivering 100 percent.\u201d<\/span><\/p>\n

\n

Ready to book a doctor’s appointment? Visit Zocdoc.<\/span><\/a><\/span><\/h1>\n","protected":false},"excerpt":{"rendered":"

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