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How to be part of a loved one’s hospital care during COVID

Hospital Visitation

Before the coronavirus pandemic, loved ones were a common sight at hospital bedsides. Spouses and grown children could get live updates from doctors and nurses and participate in their family member’s care. They were a second set of ears, a hand to hold, and someone to flag down a nurse if they noticed something was wrong.

While Cape Cod Hospital recently changed its visitation policy to include one visitor per day for non-COVID-19 patients between the hours of noon and 6 p.m., that still leaves much of the day where you can’t be at the hospital bedside of your family member or friend. Family members of COVID visitors are still restricted at all times.

“It’s really hard on the family and we understand that because you don’t get to see them and see how they are progressing or not progressing,” said Cape Cod Hospital hospitalist Ricardo Nario, MD. “The hospital has provided iPads on all the floors, especially in the COVID wing. It’s really the only way you can see anyone. The nurses have them so if you want to see them and see how they are doing, you can call the nurses station and they can put you on Facetime with them.”

Since hospital staff are busy and families are desperate for information, we asked Dr. Nario for some tips on how to make the situation easier for everyone. Here are his suggestions.

Know when to call.

Shift changes are busy times, especially in the mornings so it’s not a good idea to call between 6 and 8 a.m.

“For the doctors, the mornings are really, really busy so you are not likely to reach a doctor at that point,” Dr. Nario said. “You are more likely to get a call from a doctor towards the end of afternoon after we’ve finished rounding on our patients and taking care of any emergencies that we’ve had to deal with while here in the hospital.”

Understand that you might not get information.

Dr. Nario explained that if the patient is mentally competent, the doctor will talk directly to the patient about diagnoses and treatment. It will then be up to the patient to inform family members about their status. Many family members think that being the patient’s healthcare proxy gives them access to information, but it doesn’t.

“The healthcare proxy doesn’t take effect unless the patient is incompetent,” he said. “It doesn’t guarantee you information about the patient. Now, if a patient has a cognitive disability on some level, then we will use the healthcare proxy and call them towards the latter half of the afternoon.”

Designate one point person in the family to be the contact.

“If we’re spending five minutes talking to three different family members for each patient, we will never end our day,” Dr. Nario said.

That person can then share the news with other family members. This is also good advice even when you are getting the information directly from the patient. If someone is very ill, they might not have the energy to talk to multiple people every day, so having a designated person to talk to others is helpful.

Know who to ask for information.

The nurses provide the hour-to-hour care, so they can tell you if the patient slept well or is eating well. Truly sick patients don’t have an appetite, so eating is a good indication your loved one is on the mend. Dr. Nario said that is a question he always asks either the patient or the patient’s nurse, if the patient is unable to provide the answer.

“Nurses will have that hour-to-hour information on the patient,” he said. “They’re the doctor’s eyes and ears, too, to see if the patient is doing well or declining.”

The doctors should be the ones who give the diagnosis. They can tell you what conditions are being treated, what the treatment plan is, why the patient is still in the hospital and what is going to be required before they can go home.

It’s also important to talk to the right doctor. Dr. Nario compared hospitalists like himself to quarterbacks. They have broad knowledge of a lot of things, but if your loved one is also seeing a specialist like a cardiologist, it’s important to talk directly to that doctor too.

“What they need to do as an advocate is let the nurses know they really want to speak to the cardiologist, not the hospitalist.”

What if your loved one is in the ICU?

“Those patients are the sickest ones, obviously, so those are the ones loved ones should really worry about,” Dr. Nario said. “If you have questions or fears, call the nursing station. Make your questions known. The nurses will very strongly advocate for the doctor to call a family member.”

Don’t be afraid to ask tough questions.

If you are really worried your loved one might die, it’s okay to ask directly, because sometimes doctors are hesitant to bring up bad news.

“A less experienced doctor is not apt to give bad news,” Dr. Nario said. “They won’t lie, but they will dance around the actual truth that the person is not doing well.”

If you sense that something is not right and you can see that your loved one is not eating, not drinking and sleeping all of the time, which is all information you can get from the nurses, it’s okay to ask the doctor to be straight with you.

“That will prompt a doctor to directly answer the question rather than dance around it.”