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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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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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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woman with iv in her hand in hospital. Labor and delivery preparation. Intravenious therapy infusion. shallow depth of field. selective focus

Protecting Patients and Staff in Labor and Delivery During the COVID-19 Pandemic

As a labor and delivery nurse, I see patients at their most vulnerable and am there for them during an incredibly intimate time. After thirteen years, I am still awed and amazed at each birth I am lucky enough to be present for.

But in March of 2020, everything I knew as a nurse changed when COVID-19 reached my small community hospital.

Our struggles were two-fold — making our patients feel safe and making our staff feel safe.

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Healthcare concept of professional psychologist doctor consult in psychotherapy session or counsel diagnosis health.

The Case for Non-Police Response to Behavioral Health Crises

By Jennifer J. Carroll and Taleed El-Sabawi

People who use drugs continue to die at staggering rates, due not only to overdose from contaminated drug supply, but also due to our persistent reliance on the carceral system to respond to behavioral health crises.

This approach stems from the state-sanctioned violence of the War on Drugs. It takes various forms, including the use of police officers as first responders to behavioral health crises (including welfare checks), the excessive police use of force, and the use of potentially lethal restraint methods to subdue agitated persons. It also manifests in police officers’ use of jail cells as tools for forced “detox” believing that coerced withdrawal while in custody will reduce overdose risk or help someone “go clean” (it very clearly does not).

Evidence-based alternatives to police response for behavioral health crises exist. However, despite being both feasible and effective, these alternatives to police intervention remain the exception, rather than the rule.

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Miami Downtown, FL, USA - MAY 31, 2020: Woman leading a group of demonstrators on road protesting for human rights and against racism.

Intentional Commitments to Diversity, Equity, Inclusion Needed in Health Care

By Eloho E. Akpovi

“They told me my baby was going to die.” Those words have sat with me since my acting internship in OB/GYN last summer. They were spoken by a young, Black, pregnant patient presenting to the emergency room to rule out preeclampsia.

As a Black woman and a medical student, those words were chilling. They reflect a health care system that is not built to provide the best care for Black patients and trains health care professionals in a way that is tone-deaf to racism and its manifestations in patient care.

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Hourglass

A Medical Student Reflects on the Value of Time During the COVID-19 Pandemic

By Jess Ma

He passed away on the 107th day. After I got home in the evening, I wrote down everything I could remember about him in my journal. For many days after his death, I often dreamed I was standing in that fluorescently bright ICU room. In the dreams, I would be watching him, and then he would wake up and start speaking to me, with those bright blue eyes glittering with animation and life. I always awoke feeling a little unsettled, not by his death, but rather by the fact that I knew so intimately the ways in which he was kept alive, and yet nothing about the life he lived until just hours before his final breath.

He was an existing patient on the unit when I joined the surgical ICU team, and for 10 days I followed him, tracking how every organ system was doing each day. Everyone on the team knew there was only one way this would end; his quality of life had deteriorated so rapidly since the early summer, after a bout of necrotizing pancreatitis and multiple tragic complications; he was barely able to interact with his own body, much less his environment, and his life was propped up precariously by every possible machine that could perform the function of a vital organ. For him, no medical intervention would add more significant chapters to his story. It was just a matter of when his daughter would be ready to close the book.

Because of the pandemic, visitors were only allowed after 12pm each day. When his adult daughter came to visit each afternoon, I was told to avoid intruding on their cherished private time together. I only ever really saw her shadow behind the drawn curtain as I walked past the room; and I knew that one of the surgeons on the service (a group of surgeons rotated between trauma, acute care, and surgical ICU) would routinely give her calls or meet up with her to discuss how her father was doing, even on days he had off. Surgeons are not generally thought off as doctors who can spend a lot of time just talking to patients – after all, in the time he spent on one of those daily conversations, he could complete an appendectomy. Though neither he, nor the rest of the team, could offer a magic solution, what he offered was crucial – his time.

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Sisaket,Thailand,09 April 2019;Medical staff wearing face shield and medical mask for protect coronavirus covid-19 virus in CT scan room,Sisaket province,Thailand,ASIA.

The Future of Acute and Critical Care Nursing

By Sarah A. Delgado

We need to change the future for nurses. Even before the pandemic, nurses suffered high rates of burnout and a disproportionate risk of suicide. But the pandemic could be a tipping point that leads many nurses to change careers, leave their jobs, or retire early.

Moral distress, the consequence of feeling constrained from taking ethical action, was well-documented before the pandemic, particularly among critical care nurses providing end-of-life care. Additional research conducted before 2020 demonstrates that nurses were experiencing post-traumatic stress due to the suffering they witnessed and the demands of their work.

During the pandemic, surges in critically ill patients have led to untenable workloads. The distress of end-of-life care is heightened by restrictions on visitation and increased mortality rates. In addition, shortages of basic personal protective equipment contribute to fear and a sense of betrayal.

While the pre-pandemic state of the nursing profession was concerning, the pandemic creates imminent peril.

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