Gotlib Conn Lesley, Coburn Natalie G, Di Prospero Lisa, Hallet Julie, Legere Laurie, MacCharles Tracy, Slutsker Jessica, Tagger Ru, Wright Frances C, Haas Barbara
Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada.
Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada.
SSM Qual Res Health. 2022 Dec;2:100147. doi: 10.1016/j.ssmqr.2022.100147. Epub 2022 Aug 2.
Early in the COVID-19 pandemic restricted family presence in hospitals was a widespread public health intervention to preserve critical resources and mitigate the virus's spread. In this study, we explore the experiences of surgical care providers and family members of hospitalized surgical patients during the period of highly restricted visiting (March 2020 to April 2021) in a large Canadian academic hospital. Thirty-four interviews were completed with hospital providers, family members and members of the hospital's visitor task force. To understand hospital providers' experiences, we highlight the ethical tensions produced by the biomedical and public health ethics frameworks that converged during COVID-19 in hospital providers' bedside practice. Providers grappled with mixed feelings in support of and against restricted visiting, while simultaneously experiencing gaps in resources and care and acting as patient gatekeepers. To understand family members' experiences of communication and care, we use the theory of institutional betrayal to interpret the negative impacts of episodic and systemic communication failures during restricted visiting. Family members of the most vulnerable patients (and patients) experienced short- and long-term effects including anxiety, fear, and refusal of further care. Our analysis draws attention to the complex ways that hospital care providers and families of hospitalized surgical patients sought to establish and reconfigure how trust and patient-centeredness could be achieved under these unprecedented conditions. Practical learnings from this study suggest that if family presence in hospitals must be limited in the future, dedicated personnel for communication and emotional support for patients, families and staff must be prioritized.
在新冠疫情早期，限制家属进入医院是一项广泛实施的公共卫生干预措施，目的是保护关键资源并减缓病毒传播。在本研究中，我们探讨了加拿大一家大型学术医院在高度限制探视期间（2020年3月至2021年4月）外科护理人员以及住院外科患者家属的经历。我们对医院工作人员、患者家属以及医院探视任务组的成员进行了34次访谈。为了解医院工作人员的经历，我们着重强调了生物医学伦理框架和公共卫生伦理框架在新冠疫情期间于医院工作人员床边实践中相互交织所产生的伦理冲突。工作人员在支持和反对限制探视方面左右为难，同时还面临资源和护理方面的缺口，并充当着患者的守门人。为了解家属在沟通和护理方面的经历，我们运用机构背叛理论来解读限制探视期间偶发性和系统性沟通失误所带来的负面影响。最脆弱患者（及其患者）的家属经历了短期和长期的影响，包括焦虑、恐惧以及拒绝进一步治疗。我们的分析关注了医院护理人员和住院外科患者家属在这些前所未有的情况下试图建立和重新构建信任以及以患者为中心的复杂方式。本研究的实际经验表明，如果未来医院仍必须限制家属在场，那么必须优先安排专门人员为患者、家属和工作人员提供沟通和情感支持。
