The impact of personal protective equipment and social distancing on communication and relation between nurses, caregivers and children: a descriptive qualitative study in a maternal and child health hospital

Abstract

Aims and objectivesThe main objective was to explore the impact of personal protective equipment and social distancing on nurses, caregivers and children's communication and relationship in a maternal and child health hospital.BackgroundThe spread of COVID‐19 pandemic made it necessary to apply infection prevention and control measures, including interpersonal distancing and the use of personal protective equipment. These measures may impact communication and relationship between nurses, patients and caregivers especially in a complex environment, such as a paediatric setting.DesignA qualitative descriptive study design was adopted. Reporting followed the COREQ guidelines.MethodsSemi‐structured interviews were conducted in two wards of a maternal and child health hospital in north‐east Italy. Data were collected between September and November 2020. Transcripts were analysed using inductive content analysis.ResultsSeventeen caregivers and 17 nurses were recruited using convenience sampling.Three themes were identified, namely: “Impact on a trustworthy relationship”; “Impact on common communication resources”; and “Strategies to overcome barriers”. Participants agreed Covid‐19 infection prevention and control measures impacted key elements of family‐centred and compassionate care. Communication strategies and play were critical to overcoming the barriers encountered.ConclusionsCOVID‐19 containment measures impact communication and family‐centred care in paediatric hospital settings. There is a need for stakeholders to consider family needs in interventions aimed at controlling pandemics’ impact.Clinical RelevanceWhile COVID‐19 pandemic urgency intensified the use of PPE and social distancing, strategies to overcome issues related to family‐centred care should be considered in those wards such as oncology or infectious disease paediatric departments where these measures are continuously adopted. Beyond a greater communication awareness, strategies may comprise the implementation of virtual care to guarantee support, continuity of care and information between the child, the healthcare team and the family members that are not admitted to the hospital for safety reasons.

Impact of SARS-CoV-2 Virus (COVID-19) Preventative Measures on Communication: A Scoping Review

“…With the exception of two, all were survey-based studies ( 24 , 26 , 32 – 37 ). The two exceptions used semi-structured interviews, with one supplementing this with information from media reports and government policies ( 31 , 38 ). Nine of the ten studies reported that PPE and/or distancing caused barriers to effective verbal and non-verbal communication with patients, especially for HCPs who are D/deaf ( 26 ), and that it negatively impacted psychosocial factors such as trust and rapport, and resulted in patients (including pediatric patients) feeling fearful/anxious during appointments.…”

“…Masks have always been a part of medical practice, however, their now ubiquitous use has had broad impacts on communication within the medical context. In addition to detrimental effects on verbal interactions, masks have been reported to affect HCP-HCP and HCP-patient interpersonal relationships, decrease trust and perceived empathy, create fear and anxiety in patient, and reduce HCP's situational awareness-all of which can subsequently affect quality of care ( 24 , 28 , 30 , 31 , 33 , 34 , 36 , 38 ). Indeed, Trecca and colleagues ( 62 ) reported that more patients with hearing loss attributed problems with surgical masks to the inability to lip read than to the speech being muffled, while the study of Kratzke et al ( 36 ) found patients perceived HCPs to be more empathetic and trustworthy than when they are wearing transparent masks rather than opaque masks.…”

“…Use augmentative strategies to improve communication when wearing a mask. These include speaking slowly and clearly–shouting does not help someone with hearing loss, use gestures, when repeating a statement rephrase rather than repeat verbatim, write down key information for patients who are struggling, and do not assume that the absence of a hearing aid indicates good hearing, or that a nod implies a person has heard and understood what was said ( 37 , 38 , 58 , 61 ).…”

A Qualitative Serial Analysis of Drawings by Thirteen-to Fifteen-Year-Old Adolescents in Sweden About the First Wave of the Covid-19 Pandemic

“…Many studies are limited to needs of a specific group, often those with particular morbidities or life-situations (see Giannakopoulos et al, 2021 ; Mirlashari et al, 2021 ; Sharma et al, 2020 ; Tse et al, 2021 ). In addition, only a minority of studies are based on data generated directly by children or adolescents, with most instead relying on proxy reports from teachers, parents and other sources ( Berasategi Sancho et al, 2021 ; Evans et al, 2020 ; Ferrari et al, 2021 ; Ferraro et al, 2021 ; Fitzpatrick et al, 2020 ). In general, the extant research is framed by professionalized knowledge and frameworks, with few open explorations of salient issues from the perspectives of children or adolescents themselves.…”

Behind the pandemic: Analysis of the article on “Position statement of the international network for child and family centered care: Child and family centered care during the COVID19 pandemic”

“…Nurses knows that the presence of the family with the child throughout the hospitalization facilitates the child's involvement and participation in the care received, reducing levels of stress and anxiety for the child, with the parents' absence. The authors also describe this issue and their implications in health professional education, which an opportunity to create new communication approaches in hospital setting between nurses, children and parents (Al-Motlaq et al, 2021;Ferrari et al, 2021). The strategies used by nurses wearing masks and other personal protective equipment to facilitate verbal and nonverbal communication include involve family (parents/caregivers) are explain to parents the role of play in these circumstances; use a technological dispositive of communication; promoting parental support among other strategies (Al-Motlaq et al, 2021;Carter et al, 2021;Ferrari et al, 2021).…”