Infection prevention and control across the continuum of COVID‐19 care: A qualitative study of patients', caregivers' and providers' experiences

Abstract

Introduction Healthcare facilities adopted restrictive visitor policies as a result of the COVID‐19 (COVID) pandemic. Though these measures were necessary to promote the safety of patients, families and healthcare providers, it led to isolation and loneliness amongst acute care inpatients that can undermine patient rehabilitation and recovery. The study objectives were to (1) explore how infection prevention and control (IP&C) measures impacted stakeholders' perceptions of care quality and interactions with others and (2) investigate how these experiences and perceptions varied across stakeholder groups and care settings. Methods A qualitative descriptive study was conducted. Patients and their families from an inpatient COVID rehabilitation hospital and healthcare providers from an acute or rehabilitation COVID hospital were interviewed between August 2020 and February 2021. Results A total of 10 patients, 5 family members and 12 healthcare providers were interviewed. Four major themes were identified: (1) IP&C measures challenged the psychosocial health of all stakeholders across care settings; (2): IP&C measures precipitated a need for greater relational care from HCPs; (3) infection prevention tenets perpetuated COVID‐related stigma that stakeholders experienced across care settings; and (4) technology was used to facilitate human connection when IP&C limited physical presence. Conclusion IP&C measures challenged psychosocial health and maintenance of vital human connections. Loneliness and isolation were felt by all stakeholders due to physical distancing and COVID‐related stigma. Some isolation was mitigated by the relational care provided by HCPs and technological innovations used. The findings of the study underscore the need to balance safety with psychosocial well‐being across care settings and beyond the patient–provider dyad. Patient and Public Contribution This study was informed by the Patient‐Oriented Research Agenda and developed through consultations with patients and family caregivers to identify priority areas for rehabilitation research. Priority areas identified that informed the current study were (1) the need to focus on the psychosocial aspects of recovery from illness and injury and (2) the importance of exploring patients' recovery experiences and needs across the continuum of care. The study protocol, ethics submission, analysis and manuscript preparation were all informed by healthcare providers with lived experience of working in COVID care settings.

Patient Experience Pre-Implementation of an Enhanced Recovery After Surgery Protocol: A Qualitative Investigation

“…23 Participants described that they had to "fend for themselves", had no support, and felt lonely, much of which was directly related to the strict hospital protocols of COVID, where no visitors were allowed to ensure patient safety during the conduct of this study. 24 Timeliness of care reduces anxiety and enhances patient preparation, patient satisfaction and lowers LOS. 25 A key nurse contact or patient care navigator (PCN) may be a valuable patient advocate assisting transference of information, act as a liaison between health professionals and families, and enable better access to a range of health and social care services.…”

Attitudes towards the mixing of COVID-19 vaccinated and unvaccinated patients in multi-bed hospital rooms

“…Other international studies have described patients and staffs' experiences with social isolation, loneliness and stigma because of physical separation, including having their own room and restricted visitation due to COVID-19 policies. 18 This highlights the balance that needs to be made between theoretical interventions to potentially reduce the risk of infection and the practicalities of running the hospital and looking after patients' wellbeing.…”

An integrated review: connecting Covid-era hospital visiting policies to family engagement

“…The review includes randomized control trials (22,41), retrospective comparative studies (20,26,31,38,43,47), observational studies (29, 40), and a regression discontinuity and time to event design (24). There are qualitative studies with semi-structured interviews (21, 30,45). There are two mixed-methods studies (27,39), three narratives (23,28,42), an environmental scan (35) and an analysis on primary language availability of patient-facing policy (32).…”

“…Furthermore, few restrictive visiting policies are culturally sensitive (25) and may not be equitable. For one, not all families have the same access to technology and, therefore, cannot engage in the technology that can facilitate presence (45). Restrictive visiting policies impact culturally appropriate decision-making for patients who are members of cultures that value communal decision-making and families (32).…”