Article

Nurse bonded with families as liaison for patients with COVID-19 in ICU

July Online

Rising to the call

July 29, 2020

w200729_Lori Fensterman head shot
Fensterman

In March, when the first COVID-19 patients were admitted to the intensive care unit at Platte Valley Medical Center, in Brighton, Colorado, patient advocate Lori Fensterman was tasked with providing clinical updates to anxious and frightened family members. Families were prohibited from being at the bedside because of contagion precautions. Her special assignment at the SCL Health facility continued until the end of May, when the number of patients with the virus began to decrease.

She spoke with Catholic Health World Associate Editor Lisa Eisenhauer in mid-July about her experience and the importance of self-care for caregivers over the long-haul of the pandemic. Her comments have been lightly edited for length.

My formal role is as the patient advocate, I help resolve complaints and grievances, assist in patient experience work, associate and provider engagement, etc. After we had our initial COVID-19 patients in the ICU, our chief of staff, Dr. Steven Brizendine, saw a need for someone to help provide communication to family members, since there were essentially going to be no visitors for patients with COVID-19. He asked that I take over the task. I was slowly able to gain the help of six other nurses from various departments, but three of the nurses ended up ill with COVID-19, and scheduling conflicts impacted our goal of sharing seven day a week coverage responsibilities.  

I've never worked as an ICU nurse and it had been a couple of years since I worked at the bedside (as a registered nurse). What I ended up doing was more or less providing clinical updates to our family members based off reports from the patient's physician and bedside nurse. It's not that I completely took over the role of the physician in communication, however their schedules were so busy that they couldn't call the families every day with updates. I managed to get a phone line dedicated specifically for this new position, so that the family members could keep in touch with me throughout the day. 

I helped to provide education on COVID-19 and the illness' progression, plan of care and treatment options. I was very transparent with how their loved one was doing, even as far as daily reviewing the mortality risk based on scoring tools used for patients in the ICU. The job was not just about providing clinical education, it was also about being a supportive presence. Hopefully, I helped provide reassurance.

My work included helping to facilitate virtual patient visits with family using iPads. We had family members who were able to see their loved one while they were on a ventilator. The use of iPads also provided an opportunity for family members to say goodbye to their loved ones and be "virtually present" during withdrawal of care.

I think initially I thought that, oh, I can work really hard, really fast, long hours, because this isn't going to last very long. I went full steam ahead. The more we got into it, it was clear that, OK, this is going to last a little bit longer than I had anticipated. I felt responsible to the family members to make sure they were getting consistent care and communication, I also felt this pressure to care for myself, take some breathing room. It created a good amount of internal conflict.

Towards the end of the couple-month span of working in this role, I got to a place where after going full steam ahead for so long I was not even able to acknowledge or grieve the loss of these patients whose families I'd built a relationship with. It really does weigh on you. I think I underestimated and minimized the weight of that to the point where I had to take time away from work. That gave me a sense of appreciation for how important it is for us to acknowledge that compassion fatigue is real.

I've witnessed highly skilled physicians working at a new level of intensity. Typically, they have specialists they can turn to if they don't know what to do, but with COVID-19 they're having to try things on the fly. It's so tough for them because they are fighting for these patients so hard and grasping at whatever they can to keep them alive. In regard to the COVID-19 patients that we're discharging now, it's a testament in part to the doctors who have continued to put forth all their effort to stay up to date on the best treatment for these patients. 

As we as a hospital, as a health care system, as a world, move into whatever we're calling it, the new normal, or we're just pressing ahead, it is important not to deny that our caregivers are still in the thick of it, and do whatever we can do to try to help them through it all. I'm concerned about the associates and the providers who don't see a light at the end of the tunnel.

There is a very real component to this illness that it can affect people that would have been looked at as normally healthy. We had a patient who is in his early 40s. He and his wife and daughter just came back to the hospital to say thank you to the staff. He had no prior conditions and ended up on a ventilator for over two weeks, stayed in the hospital for over a month. And it just was out of the blue. So, the illness can just hit people from left field, and oftentimes it doesn't seem like there's any rhyme or reason. People who don't work in health care need to become educated and to have a healthy fear. Not live out of fear, but to learn about the disease and how to keep themselves well and prevent the spread of it.

As hard as the position was, I felt honored to be able to be there for those families during this time. And I think it gave me a new perspective about a lot of different things, even in the type of life that I want to live. I think that can be true for any of us, if we allow the opportunity for this pandemic to change the way that we view our neighbors and our outlook on the world, we could all change for the better.

Click here to read more profiles in the Rising to the Call series.

Copyright © 2020 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.