Responding to no‐visitor policies during the COVID‐19 pandemic: Virtual care initiatives for hospitalized patients

At the time of writing, the COVID-19 pandemic has provided challenges to health services globally for close to 2 years. These challenges have included the need for enhanced infection control procedures, markedly increased demand for services, rapid upskilling and redeployment of the workforce, support for staff physical and psychological welfare as they deliver services and deal with considerable loss of life, and in many settings, responsibility for vaccine rollout. Many services have faced significant changes to daily operations, and previously unproblematized and uncomplicated aspects of service delivery, such as the presence of visitors in hospitals has been affected. Many hospitals and other health services have had strict restrictions in place about visiting, as one strategy for keeping COVID-19 out of hospitals.

While the implementation of no-visitor policies has been necessary to protect the health of patients and the workforce in hospitals, such restrictions have also caused hardship to patients, families and staff. Many approaches to healthcare assume that family support (however defined) is available to patients, and that family members will be involved in care and decision-making. These approaches depend on authentic and reliable communication involving the patient, family members and health care personnel. Furthermore, visiting of friends and family can be a significant variable to the emotional well-being of patients and their loved ones and a great source of comfort to families experiencing the illness or incapacity of a family member. Thus, visitation restrictions in hospitals implemented during the COVID-19 pandemic has resulted in significant barriers to communication among clinicians, patients and families. No-visitor-policies not only have emotional impact on patients and their loved ones, but also have negative impact on patient and family-centred care initiatives due to suboptimal communication. The effects of no-visitor policies can be particularly difficult for patients and their loved ones where the patient may lack capacity, have language barriers, are critically ill or otherwise dependent on their carers. Family members can become very anxious, distressed and even distraught when unable to visit with loved ones while in hospital. Meanwhile staff who are already pressured and may also experience communication impairment due to the effects of personal protective equipment (PPE), are called on to provide additional emotional support to distressed patients and their loved ones.

The importance of visiting means that health services personnel have been challenged to provide alternative means of ensuring patients can have meaningful contact with loved ones, while maintaining the restrictions necessary to reduce the spread of infection. Virtual care initiatives have been implemented in many settings. These initiatives have the advantage of providing ways that friends and family can visually and verbally engage with their family member, and connect with the health care team. It can allow for patients to have their family members (virtually) present for the purposes of visiting, as well as family-centred care initiatives. It is especially helpful given that many people have been (and many still are) affected by travel restrictions, which has imposed additional difficulties for families dealing with the illness or incapacity of a loved one.

Virtual care is not a novel technology. Various forms of virtual care have been used in healthcare for several years (Webb et al., 2020). However, the pandemic has seen much more rapid and widespread implementation of virtual care and virtual visiting in hospitals to replace or supplement in-person visitation.

Available literature supports the implementation of virtual care. Licurse (2016) describes the use of virtual visits for outpatients with chronic diseases where 97% of patients reported satisfaction with the experience and 74% felt the virtual interaction in fact improved their relationship with the care provider. During the current pandemic, virtual care has been particularly useful in intensive care units, with National Health Services (NHS) hospitals in the United Kingdom (n = 117) reporting changes in ICU family visiting policy during the COVID-19 surge (Rose et al., 2021). The vast majority of these hospitals (97%) had adopted virtual family visiting, and the most common indications identified were to alert and orient patients, and to facilitate family interaction for patients at the end of life (Rose et al., 2021).

There are many benefits of virtual visiting, including reduced patient psychological distress, improved staff morale, reorientation of delirious patients with help of family, overcoming language barrier and enhancing patient-centred care (Rose et al., 2021). Use of virtual care can not only enhance the quality of life for patients and their loved ones, but also lead to additional benefits such as reducing anxiety and allowing non-vocal patients to communicate via computer keyboards (Nusdorfer, 2013). Furthermore, Angus and Connolly (2020) describes multiple uses of virtual care in healthcare system in the context of COVID-19 pandemic, such as monitoring patients with milder COVID-19 symptoms in their homes, being able to ensure effective contact and involvement of quarantined health workers and providing continuity of care for people with chronic illnesses remotely.

Virtual care is not only relevant in the emergent COVID-19 pandemic. Looking beyond the pandemic, virtual care initiatives have long-term potential to enhance and broaden delivery of future healthcare. Virtual visiting will continue to be beneficial for families who are unable to attend hospitals regularly (Cheney, 2020; Webb et al., 2020). Use of virtual clinics could allow patients who are at a distance or have other difficulties physically attending appointments to continue to receive optimal healthcare, have increased compliance and have reduced cost of travelling.

There are however some barriers to widespread adaptation of virtual care. This includes staff availability to facilitate video calls, provision of training for staff and concern for security and privacy (Rose et al., 2021). Furthermore, some healthcare providers may have difficulty implementing virtual care in their practice due to financial constraints, technological incompetence and difficulty with remote assessment with visual cues (Angus and Connolly, 2020). Some patients and family members may have difficulty with videoconferencing capability or may not have access to virtual devices (Rose et al., 2021). These barriers should be considered for effective implementation of virtual care in the future.

While further research is needed to ascertain the qualitative experiences of patients, their families and friends and health care staff, and to provide thorough and accurate cost-benefit analyses, we argue that virtual care initiatives can provide important and tangible benefits to patients and families as well as to health care providers, especially in the current context of no-visiting policies and other visiting restrictions. The effective utilization of virtual care during the COVID-19 pandemic provides an opportunity for change in the future of healthcare delivery.

CONFLICT OF INTEREST

No conflict of interest has been declared by the authors.

AUTHOR CONTRIBUTIONS

All authors have agreed on the final version and meet at least one of the following criteria (recommended by the ICMJE*): (1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content.

留言 (0)

沒有登入
gif