PPE portraits: Patient and clinician experiences at a COVID-19 testing site

Abstract

Context: The COVID-19 pandemic mandated personal protective equipment (PPE) in healthcare settings, obscuring clinician faces and expressions, and depersonalizing patient care experiences. PPE Portraits (affixing a clinician's photo to the front of PPE) was first introduced in 2015 during the West Africa Ebola epidemic, and has been shown to help maintain patient-provider connection at times when patients may be fearful, isolated, and unable to identify clinicians caring for them. Objective: To evaluate patient and clinician experiences with PPE Portraits. Study Design: Implementation pilot with mixed methods evaluation. Setting: A drive-thru COVID-19 testing site affiliated with a large academic medical center. Population studied: Patients (n=18) and clinicians (n=6) interviewed in March-April 2020. Clinicians were recruited through convenience sampling. Clinicians answered questions via recorded interviews or email. Patients were interviewed by phone through random sampling stratified by date of service. Patients were sent a post-visit survey. Intervention: Health workers affixed a PPE Portrait in order to connect better with individuals in their care. Outcome Measures: Patient and clinician experiences with PPE Portraits (assessed through inductive coding of qualitative data) and patient experiences with fear (assessed through survey). Results: Patient surveys indicated varying levels of fear, including mild (16%), moderate (66%), and severe (18%). Patients reported that seeing the PPE Portrait was comforting; four patients stated that it did not impact their care because they already trusted the facility. Clinicians corroborated patient sentiments, reporting that the intervention humanized both the testing experience for patients and also the interactions among patients and clinicians. They noted that patients seemed more at ease and that portraits fostered connection and trust, thereby reducing anxiety and fear and signaling to patients that they were being given holistic, optimal care. A majority of clinicians felt this intervention should be replicated, and they recommended having surplus portrait supplies on site to facilitate ad hoc portrait creation. Conclusion: PPE Portraits humanized the COVID-19 testing experiences for patients and clinicians during a time of fear. Clinicians recommended PPE Portraits for other healthcare settings that require PPE. Future research could assess how PPE Portraits promote patient-provider connection and trust.

Personal Protective Equipment Portraits Canada (PPC)–Humanization and surveying mask-wearing nationally

“…PPC serves as an example of how highly accessible online platforms can be incorporated into institutional logistics and workflows to maximize efficiencies of scale, save time, and increase the impact of healthcare initiatives, all while limiting contact and respecting infection control regulations during a pandemic. It also demonstrates how simple medical art interventions can have a measurable and large-scale impact on patients and HCWs, especially given the fear experienced by patients; one study showed that 66% and 18% of patients going to a drivethrough COVID-19 testing centre experienced moderate and severe levels of fear respectively [7].…”

“…In collaboration with Sunnybrook, a 16-question bilingual anonymous pilot survey was sent to PPE portrait recipients at a minimum of 1 month after having mailed the portraits. This survey was developed from previous research that collected data from a COVID-19 testing site [7]. AS created the first draft, received feedback from her interdisciplinary team at the Sunnybrook Health Sciences Centre, and further edits were given by AAD.…”

Influence of protective clothing and masks on facial trustworthiness in an investment game: insights from a Chinese population study

“…Future research could use protective clothing to cover faces with different levels of initial trustworthiness to investigate the role of facial information in trustworthiness judgments. In addition, research has found that placing a portrait on the outside of protective clothing can help medical personnel connect better with the individuals in their care (Winter et al, 2022 ). Patients seemed more at ease, and the portraits fostered connection and trust, thereby reducing anxiety and fear and signaling to patients that they were being given holistic, optimal care.…”

“…However, masks and protective clothing can reduce the number of facial cues that are available as they partially cover the mouth and nose or completely cover the entire face. This may lead to decreased facial expression identification (Kotsia et al, 2008 ; Winter et al, 2022 ) and impair observers' ability to accurately identify the faces of target individuals (Carbon, 2020 ; Carragher & Hancock, 2020 ; Winter et al, 2022 ). Criminals often use facemasks for this reason.…”

“…The COVID-19 pandemic mandated the use of personal protective equipment (PPE) in healthcare settings, obscuring the faces and expressions of clinicians and depersonalizing patient care experiences. When patients cannot identify the clinicians caring for them, they may feel fearful and isolated (Winter et al, 2022 ). This issue has been observed in certain healthcare areas in the past.…”