Physical therapist helps person in wheelchair.

How the COVID-19 Pandemic Has Changed Caregiver Education and Training

By Elizabeth Hansen

As a Physical Therapy Practice Leader, I help patients at the rehabilitation level of care — patients who have sustained a significant injury or disease that has life-changing implications.

Caregivers play an important role in the discharge of these patients from the in-patient context back to the home. They take on the burden of learning the techniques and interventions recommended by the clinical team. They may be learning how to use and maintain new equipment, such as power wheelchairs, feeding tubes, and lifts.

During the COVID-19 pandemic, I have noticed increased distress among both health care providers and family caregivers as patients are getting ready to discharge home, due in large part to challenges posed by the pandemic to family health care education.

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DUQUE DE CAXIAS,(BRAZIL),MAY,20,2020: doctors take care of patients with covid-19 and an intensive care unit (ICU) at hospital são josé specialized in the treatment of covid-19.

From Pain to Progress: Nursing After the Pandemic

By Victoria L. Tiase and William M. Sage

America’s nurses are a powerful force for good — four million strong, universally trusted, increasingly diverse, serving every community across the country, with an overall economic impact greater than the total output of the median American state. However, the pain of pandemic nursing is real and widespread. Urgent attention to nursing’s vulnerabilities is required for the profession to help the U.S. emerge from the confluence of the worst public health crisis in over a century and the most severe economic decline since the Great Depression.

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Passport in suitcase.

Ethical, Legal, and Scientific Challenges for COVID-19 Vaccine Passports

By Chloe Reichel

As COVID-19 vaccines become more widespread, passports that certify immunization status may facilitate a return to normalcy, write Lawrence O. Gostin, I. Glenn Cohen, and Jana Shaw in a viewpoint published today in JAMA.

But these vaccine passports, or digital health passes, are not without scientific, legal, and ethical challenges.

I asked Gostin, Faculty Director of the O’Neill Institute for National and Global Health Law at Georgetown University Law Center, Cohen, Faculty Director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, and Shaw, a professor of pediatrics at Upstate Medical University, about the key areas of concern and promise for vaccine passports. Our conversation, which has been edited and condensed, follows.

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ANDOVER,HAMPSHIRE/UNITED KINGDOM-NOVEMBER 6 2019:A district nurse visits a ninety-four year old patient at his home to treat for pulmonary edema and head/brain injury.

Challenges Facing Home Health Caregivers During COVID-19 Pandemic

By Vicki Hoak

The pandemic has emphasized the value of home health caregivers. Their contribution has been overshadowed for decades, but now it is very clear how important their work is to the well-being of older Americans, people with disabilities, and medically-fragile children.

As families were urged to stay at home to stop the spread of COVID-19, home care agencies and their staff became all the more important for preventing the spread of COVID-19 and protecting the most vulnerable from the disease. Home health aides offer clients one-to-one care and continual monitoring of changes in conditions — all in the safety of one’s own home.

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Senior citizen woman in wheelchair in a nursing home.

Telehealth and the Future of Long-Term Care

Join us on Wednesday, April 7 for further discussion of these issues during our virtual event, “Triumphs & Tensions of the Telehealth Boom.

By Tara Sklar

The COVID-19 pandemic accelerated the trend away from providing health care and long-term care in institutional settings in ways not previously imagined; the result of a reckoning with the massacre that disproportionately killed hundreds of thousands of older adults living in nursing homes or similar congregate facilities, along with the staff who cared for them.

Beyond the immediate staffing and infection control issues at hand, this juncture leads to a larger question, in the U.S. and abroad: how can we best care for an older population in the decades — and not just years — ahead?

The major advances and shortfalls that have surfaced during the pandemic around telehealth and its related technologies in digital home health care are essential to this discussion.

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hospital equipment

How COVID-19 Has Widened the Experience-Complexity Gap in Nursing

By Julie Miller

I am a Clinical Practice Specialist for the American Association of Critical Care Nurses (AACN), and I have noticed the experience-complexity gap widening during the pandemic. As increasing numbers of nurses retire due to the stress of serving on the front lines, novice nurses are tasked with complex caseloads.

Hospital-based educators tell me they do not have enough experienced nurses to oversee and mentor the novice nurses due to attrition, as experienced nurses are taking advantage of high paying travel contracts, or are leaving the ICU/PCU specialty due to burnout, moral injury, and post-traumatic stress.

Post-pandemic, the experience-complexity gap for progressive and critical care nurses will continue to widen and affect intensive care unit (ICU) and progressive care unit (PCU) orientation and ongoing education.

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Doctor Holding Cell Phone. Cell phones and other kinds of mobile devices and communications technologies are of increasing importance in the delivery of health care. Photographer Daniel Sone.

Viewing Telehealth Policymaking Through the Lens of Disability

Join us on Wednesday, April 7 for further discussion of these issues during our virtual event, “Triumphs & Tensions of the Telehealth Boom.

By Laura C. Hoffman

As a means for delivering health care, telehealth will only be as successful as it is accessible to our most vulnerable populations.

Although the utilization of telehealth has the great potential to increase access to health care while simultaneously reducing barriers to access for individuals, people with disabilities face multiple barriers to telehealth. The COVID-19 pandemic has further highlighted these challenges.

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Field hospital in NY during COVID-19 pandemic.

Ethical and Legal Challenges Faced by Hospitals in New York’s First COVID-19 Surge

By Zachary E. Shapiro

After COVID-19 reached the United States, New York City quickly became the epicenter of the pandemic. Clinicians at New York Presbyterian Hospital-Weill Cornell Medical Center turned to the Clinical Ethics Consultation Service to help meet the ethical challenges that arose. During the surge, the Ethics Team saw a marked increase in the volume of consultations for individual patients in the hospital, and took part in over 2,500 informal consultations with caregivers. Discussions centered around a wide range of ethical issues distinct from those that come up in routine practice. As one of the only lawyers in the Division of Medical Ethics at Weill Cornell Medical College, I encountered a myriad of legal concerns presented by the pandemic.

During the height of the surge in New York, there was no formal legal guidance available to clinicians concerning medical practice during a pandemic. Questions about legal immunity abounded, as unclear state and federal guidance left many doctors worried that they were taking personal and professional risks by providing care to COVID-19 patients.

The pandemic forced doctors to shift away from traditional standards of care in terms of resuscitation, patient care, and surrogate decision-making. The ethics team had to take new dynamics into account, such as the risk of infection to doctors and staff, and balance these factors in the risk/benefit calculations for treatments and interventions. Undertaking these shifts without federal or state guidance caused significant distress and concern. It often seemed that the law was not only not helpful, but an active hindrance to medical practice, as many health care workers were consumed by worry about the prospect of future liability. This concern persisted, even though the deviations in the standard of practice were necessitated by the realities of the pandemic overwhelming our health care system.

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