Being person-and-family-centred during COVID-19
What does it mean to be person-and-family-centred during a pandemic? That is the question we asked some of the Ontario Health Teams that participate in RNAO’s Best Practice Spotlight program (BPSO OHTs).
During Knowledge Exchange calls and other meetings, BPSO OHT teams from across the full continuum of care shared ideas, resources and lessons learned. Some said that person-and-family centred care (PFCC) was the cornerstone of their pandemic response. Others said that PFCC has become even more important now – not only for the people and for families they care for, but also for staff.
Below is a summary of challenges and solutions discussed in our meetings.
Challenges during the pandemic
Social distancing means being isolated from loved ones, separated from social networks, and having to make tough decisions, like which sibling would visit a dying parent. It also means huge adjustments in the way that care is being offered. In the community, most in-person visits have been cancelled and replaced by virtual care.
Meanwhile information about COVID-19 is constantly evolving. This creates uncertainty and fear. It also means that organizations need to rapidly create policies and protocols and communicate these to staff, patients and families.
Care has become more complex. Chronic diseases are compounded by isolation, loneliness and poverty. Some people require logistical help, like accessing basic supplies and food. More people are experiencing emotional distress or mental health crisis.
Isolating at home has additional challenges for people living in close quarters. The risk of domestic violence has increased, and having confidential conversations or a private virtual visit is near impossible.
The increased reliance on technology has exposed inequities. Many people lack phones, phone plans or inadequate internet access. Those unfamiliar with technology need to gain new skills so they can connect with family or health providers.
Person-and family-centred solutions
Helping people stay connected:
- Sourcing phones and tablets, arranging internet access or helping people find ways to access free wifi or data plans
- Teaching people how to navigate social media accounts
- Facilitating contact with families through video calling (FaceTime, WhatsApp)
- Arranging “window visits”, especially for those in nursing homes
- Establishing new group virtual exercise classes and book clubs to promote health and address social isolation
Supporting mental health:
- Calling more frequently to assess evolving needs
- Applying the principles of person-and-family-centred communication (e.g., listening, therapeutic communication)
- Redeploying psychotherapy staff to provide telephone based counseling services
Communicating clearly and often:
- Sharing information regularly about what is known/unknown
- Being transparent about limitations (e.g., visiting)
- Establishing one consistent point person to work with families and provide updates about their loved ones
Assessing evolving needs:
- Calling daily or every 48 hours to assess coping, or to review goals and needs
- Developing “call scripts” to support the different types with questions that need to be asked as the pandemic evolves
- Adapting care plans based on changing needs
Meeting tangible needs in new ways:
- Partnering with community organizations and pooling resources to provide logistical support (e.g., helping people move from shelters to apartments, arranging delivery of groceries, medications or packages of essential needs)
- Ensuring continuity of care; having regular nurses to visit virtually or in person to address complex chronic diseases and social complexities
Being person-centred with staff
The BPSO OHTs also emphasized the need to take a PFCC approach to support staff. Here is what they said:
Meeting the emotional needs of staff:
- Acknowledging fears and concerns
- Meeting more frequently to offer support and help staff transition to new roles/approaches to care, dealing with decreased staffing
- Providing a “Wellness Cart” (e.g., with snacks, water, hand sanitizer)
- Offering virtual/phone counseling
- Responding to “Lavender alerts” to help staff cope and reduce the risk of PTSD (this is an immediate system of support for staff in crisis delivered by pastoral services or trained staff)
Keeping staff informed:
- Addressing uncertainties with increased communication
- Hosting Town Halls with senior leadership that address staff questions
Reflecting and celebrating:
- Taking the time to reflect with teams during the pandemic and documenting lessons learned
- Celebrate small wins and big successes
The RNAO BPSO coaching team thanks the BPSO OHTs for sharing the outstanding work they are doing to care for people and their families during this pandemic. We are impressed by the creative, flexible and swift solutions as well as the effective collaborations within your organizations, BPSO OHTs, and the greater community. We look forward to learning more from you and supporting your ongoing clinical excellence.
Learning from our readers: Your examples
Do you have examples of how you or your organization has been person-and-family-centred during this pandemic? Please share with us! Email Oliwia Wilson with the subject line “PFCC during pandemic.”