Nurse Professors as Patients During COVID-19.

Introduction

The ongoing COVID-19 pandemic has highlighted nurses' knowledge, skills, and attitudes to care for patients. Nurse professors who have experienced the patient role during the pandemic have a distinct awareness and compassion for nursing during these challenging times. Our perspective as nurse professors and patients on the ability of the nurse and health care team to communicate has never been more critical than in this time of unprecedented health emergency.

Why is Communication Important in Nursing?

Events such as the COVID-19 pandemic, where health care systems and those that work within them are challenged, require the ability to sift through information from diverse sources (1). Communication is vital for nursing care. Communication, defined as “transferring thoughts, information, emotion, and ideas through gesture, voice, symbols, signs, and expressions from one person to another” (1), represents essential skills not only in collaboration with other nurses but within the interprofessional health care team.

The pandemic has intensified communication weaknesses already present in our healthcare system. Mandates around isolation requirements and limited family visitation have been a catalyst for telehealth use, which itself may be a barrier (2). Lack of effective communication regarding status changes, critical information, or unclear orders may negatively impact patient safety (3).

Nurses are often the core of team communication. Responsibilities include sharing and interpreting information between physicians, nursing colleagues, patients, and family members. The ability to communicate effectively begins in the classroom. Person-centered care and the critical role of effective individualized communication is an essential attribute of nursing practice (4).

The pandemic has exposed new challenges to manage related to quality and safety of healthcare and communication. The nursing professor's perspective from the patient's point of view is infrequently found in the literature. During this unprecedented time, it is imperative to develop an understanding of patient care through the eyes of those that know the challenges nurses face daily.

The following vignettes, representing two nursing professors’ interactions with the health care system, illustrate system and process limitations where communication patterns played a significant role in patient outcomes. The goal of highlighting these challenges is to support nurses and enlighten system administrators about the daily challenges our nurse colleagues face. The first vignette offers a nurse professor's view of communication challenges while newly diagnosed with a chronic health condition during the pandemic.

Rita, 59, a nursing professor at a local university, had several life-changing stressors co-occurring, accompanied by weight loss, exhaustion, and confusion with little improvement despite increased sleep. Routine laboratory results showed a glycosylated hemoglobin (HbA1c) of 11 when 6 months prior it was 5. A diagnosis of diabetes type 2 was made, and the primary care provider prescribed oral medications. Rita did not receive any patient education or referrals. About a month later, the exhaustion had not lessened, and she seemed to have unclear thoughts. Rita received a glucometer, and blood glucose results were consistently over 600 mg/dL. The primary care provider did not respond to Rita's multiple electronic messages and phone calls.

Meanwhile, her HbA1c level increased to 14, and insulin-dependent diabetes was diagnosed with ketoacidosis becoming a real risk. Eventually, following a colleague's intervention, the primary care provider responded and stated that the messages had not been shared from the electronic messaging system since his office staff screened these. From diagnosis to initializing insulin as a treatment to control blood sugar results took over 9 months.

The second vignette illustrates the impact of ineffective communication on the safety and quality of patient care in the acute care setting during the pandemic:

Nancy, 50, presented to the Emergency Department with symptoms of peritonitis and underwent emergency surgery. Due to COVID-19 restrictions in the hospital, no visitors were allowed in the post-anesthesia care unit (PACU). Intensive care unit (ICU) beds were also unavailable due to COVID-19 patients, leading to an extended stay in the PACU (4 days). She frequently was unable to get her nurse's attention due to the PACU not being equipped to handle this type of patient. Limited communication was shared with Nancy's husband, who the surgeon only called immediately after surgery. Her husband had limited information by texting Nancy, who infrequently responded due to pain, IVs, medications, and general exhaustion. Nancy's husband was finally allowed to visit her when she was transferred from the PACU but was still not kept informed about her status by nurses, physicians, or other providers but only via Nancy herself who was not at her cognitive baseline.

During the pandemic, the health care team is overwhelmed with information and changing circumstances. It is often difficult to consider clear communication as a priority (1). As nursing professors, Rita and Nancy understand the health care system. Most people do not have this advantage, and incorrect, delayed, or absent communication as seen in these scenarios may cause anxiety, frustration, and panic. The pandemic highlights the urgency for practical, focused ways to communicate with patients and families (1). Patients have unique concerns, and nurses should personalize communication to their individualized needs (5). The health care team must offer clear, targeted information with key points repeated for understanding (5). Information should be delivered by methods that the patient and family prefer (5). Technology such as text messages, voice mail, email, and telehealth can be leveraged to support patient and family connectedness. Empathetic, active listening can impact effective therapeutic communication with patients and families (6). Listening and hearing what is said is fundamental to nursing and caring for patients (7). Listening involves more than just asking questions. Nurses should be interested, mindful, and flexible while listening. Focusing on the person answering the questions sometimes offers information of which the nurses weren't aware (8). The ability to fully hear issues of concern without judgment allows true tailoring of care interventions (7). It is empowering for patients to decide what is best for their care.

As nurse educators, we realize the value of providing an effective communication foundation to our nursing students. The pandemic has highlighted the opportunity for healthcare organizations to expand and mentor healthcare team members on these essential skills. The care and well-being of our patients are at the center of what we as nurses do. Effective communication while we navigate this crisis has never been more critical.