The past two months with COVID-19 have been unlike anything the healthcare system has ever witnessed. Please view the Relias webinar for an in-depth discussion of the grief issues that this pandemic has created. Patients who are seriously ill with the coronavirus are physically separated from their families due to risk of viral spread. Patients are dying alone, and families are having to say goodbye to their loved ones over cell-phones and I-Pads.
During the webinar, we had many thoughtful questions. I’ve taken the time answer some of them below.
“Why are we keeping families from those who are dying?”
Most institutions have put in place very strict guidelines for family visitation. Allowing family to be with patients with COVID-19 puts the family members at risk, and those family members entering and exiting the hospital/facility are putting all in the healthcare system at increased risk.
The only way to slow the spread is to isolate. Some institutions have made allowances for one family member to stay with a loved one who is actively dying. That family member is not allowed to leave the patient’s room.
As states start to open up again, we will see these rules lifted but safety of the community has been the top priority during the peak of the viral spread.
“Are there different layers to this traumatic experience of the pandemic?- from a crisis stage, to a new normal?”
We are all living through a time unlike any other. Most disasters have three phases:
- Impact phase
- Recoil/rescue phase
- Recovery phase (new normal) (Mirabito, 2017).
Nearly all states have gotten through the impact phase and many states are through the rescue phase and starting a new normal (recovery). It is during this new normal phase that we are trying to figure out next steps.
Those who have experienced loss and had to delay funerals are considering when and how to grieve lives lost. Healthcare providers are trying to cope with having witnessed multiple and in some ways traumatic deaths (as persons died alone, without family). Many are at risk for a type of post-traumatic stress syndrome, called secondary stress.
We are already hearing of an increase in anxiety and depressive symptoms across the US (https://mhanational.org/covid19).
Many of you responded compassionately to the lack of morgue/funeral home issues, especially in the “hot spot” cities.
It has been a terrible stressor for family members, struggling to find a funeral home to take their loved ones’ body. My colleagues in NYC have helped with this answer:
I am happy to report that things are much better in NY as of the end of May. Daily deaths are down below 100. The city did get help from out of state morgues to address the issues they were having and as of now there are no families struggling to find a funeral home/morgue for their loved ones.
NY will still keep their refrigerated morgue set ups behind the hospitals in case there is a surge in the fall.
“How do we attend to unique cultural needs, in particular for Native Americans and those who are developmentally disabled?”
There are over 560 Native American tribes, each with their own diverse cultural traditions surrounding serious illness and death. It is important to ask each individual patient and family struggling with COVID 19 what is important to them. For many Native Americans, advance care planning is a violation of traditional values. Many prefer not to talk about terminal illness, for fear that talking about it, might make it happen. For those facing a rapid decline from COVID-19, it may be culturally inappropriate to ask about treatment preferences. Many tribes have wakes at home or in church before burial, with family members staying up all night (Colclough, 2017). With the coronavirus and the lockdown, these rituals may not be possible.
It is important to note that like other minority groups and lower income populations, the coronavirus has had serious effects on health and the economy of the tribes. The Navajo nation has the 3rd highest per capita rate of COVID-19 after NJ and NY. Those with multiple comorbidities are at higher risk for serious illness with COVID-19. All tribes have seen their economies suffer as their usual sources of income have closed (i.e. crafts, pottery, casinos).
For those with disabilities, there are special considerations for supporting them during the pandemic. It is critical that they are educated about the virus in a developmentally appropriate way. The ARC has some materials that can be helpful: COVID Materials in plain language. All persons with disabilities need to have a plan for what to do if their caregiver(s) or direct support provider gets sick; two methods of communication, in an emergency, (i.e. cell phone, email); and a 30-day supply of groceries, household items and medications (CDC, 2020).
A number of you asked about supporting children during this crisis. “Do masks and gloves traumatize them? What are resources for adolescents suffering with anxiety?”
The CDC has a nice single facts page on how to support children through this pandemic:
From the Association of Childlife Specialists: Here is a list of great resources ranging from how to talk with children and teens about COVID-19, how to talk with children whose parents or grandparents have the coronavirus etc.
And on that website is a coloring book from St. Jude’s Childrens Hospital that talks about wearing masks and PPE and tries to decrease the anxiety children might have seeing this equipment.
Finally, a number of pediatric, as well as long-term care, resources are available on the End-of-Life Nursing Education Consortium (ELNEC) COVID-19 website.
- Colclough, Y. Y. (2017). Native American Death Taboo: Implications for healthcare professionals. Journal of Hospice and Palliative Medicine, 34,(6), 584-591.
- ELNEC COVID- 19 Website: https://www.aacnnursing.org/ELNEC/COVID-19
- Mirabito, D. (2017) Social work theory and practice for crises, disaster and trauma. In F. Turner,(ed.) Social work therapy: interlocking theoretical approaches.