Introduction
The Coronavirus Disease 2019 pandemic, commonly abbreviated as COVID-19, has triggered a rapid and evolving healthcare landscape that currently affects communication between families, patients, and healthcare providers, a core element of patient-and family-centered care (PFCC). PFCC is a healthcare delivery approach that enhances the planning, evaluation, and provision of health care based on the mutually beneficial relationship among health care practitioners, families, and patients (Piscitello et al., 2021). The aforementioned practice’s core conceptions emphasize regular communication with one’s household members, multidisciplinary support, and family presence at the bedside (Wu et al., 2020). However, the COVID-19 pandemic and the government’s restrictions for minimizing its spread impact healthcare providers’ capacities to meet the above-mentioned primary PFCC goals.
Currently, healthcare settings globally have imposed regulations that limit patient visitations in an attempt to minimize SARS-CoV-2 transmission. However, Hart et al. (2020) associate this primary mitigation approach for reducing the virus’ spread with the adverse effects on PFCC delivery. To resolve this issue, many intensive care units (ICUs) have shifted their clinical visitation and communication approach from the bedside and in-person discussions to remote interactions exclusively via video call or telephone (Lieneck et al., 2020). Nevertheless, despite the widespread telehealth utilization to facilitate communication, several barriers still hinder this strategy’s efficacy (Monaghesh & Hajizadeh, 2020). This paper provides a literature review on the issues and best practices related to telehealth communication between family and admitted patients in an ICU during the COVID-19 pandemic.
Challenges Linked to Telehealth Communication
One of the primary issues linked to effective telehealth communication between families and patients during the COVID-19 pandemic involves their inadequate knowledge of the pertinent telehealth communication software. The proper usage of virtual software platforms and digital communication technologies might be challenging for specific citizens due to their deficient cognizance of the innovation (Piscitello et al., 2021). Studies further identify network communication quality as a primary factor that affects telehealth communication’s implementation (Lieneck et al., 2020). Poor and uncoordinated technology adoption by families, particularly those in rural regions and in developing nations, represents a significant hurdle to the effective use of modern virtual communication approaches (Anthony, 2020). Slow Internet speed, Internet access issues, poor signal coverage, wireless issues, as well as poor audio and video quality negatively impact telehealth communication between families and patients, causing frustration and a sense of helplessness (Wu et al., 2020).
Security protection, access, and data privacy are crucial issues that affect digital communication technology’s use within healthcare settings to promote family-centered care. This innovation’s adoption entails exchanging sensitive information between clients and their families, which could cause security-related risks (Alghamdi et al., 2020). Currently, there are no underlying regulations that safeguard patients and families using IT-enhanced communication technologies to connect. The US Department of Health and Human Services (HHS) does not penalize healthcare settings for utilizing non-HIPAA compliant software, particularly during this COVID-19 pandemic (Hart et al., 2020). The above-mentioned viewpoint is supported by findings from a study by Schwamm et al. (2020). In the survey, ninety-four percent of the participants identified data protection laws as limiting factors for the implementation of virtual communication approaches (Schwamm et al., 2020). Therefore, the aforementioned security-related vulnerability acts as a significant barrier to telehealth communication’s adoption in healthcare settings.
Additional drawbacks linked to telehealth communication between families and patients include challenges related to video and phone media, for instance, the dearth of body language and non-verbal cues. According to Kennedy et al.’s (2020) study outcomes, the lack of embodied cues during phone conversations triggered the improper use of “silence” during an interaction, uncertainties regarding the comprehension of the data shared, families’ inability to express emotions, and difficulties holding high-stake discussions. Families identified that communication could be improved by positioning the camera to mimic the experience of being at the bedside so that family can see the patient and surroundings. Furthermore, families should be given the opportunity to ask questions about treatments and devices, as well as offer time for family-patient communication without clinician participation (Kennedy et al., 2020).
Sasangohar et al. (2020) also conducted a study on telecommunication between families and patients in the ICU. Families noted issues in communication and technical difficulties. There may be issues with communication due to patient status, such as them being intubated, medicated, or sleeping. A minority noted that virtual visits also impacted the frequency and quality of communication with the care team, concerned with the duration of the call and ability to effectively schedule communication with both the patient and the attending physician. There are also issues of technicality such as the inability to heart the patient because of background noise and equipment, along with standard connection instability. Potential improvements based on family recommendations include on-demand access, a major theme expressed by the majority of participants to be able to initiate calls. Other expectations are improved communication with the care team by receiving frequent updates and improving technical capabilities to enhance stability and quality of communication (Sasangobar et al. 2020).
Best Practices for Telehealth Communication
Telehealth communication represents a safer option for health care practitioners, families, and patients by minimizing prospective infectious exposures. Furthermore, according to the findings of a study by Kennedy et al. (2020), this technology acts as an appropriate alternative to in-person communication for patients, clinicians, and families. The survey further revealed that the utilization of communication approaches specific to video and phone enhances better family and clinicians’ experiences with this innovation (Kennedy et al., 2020). This section provides an overview of the best telehealth communication practices recommended by different scholars.
Some of the best practices for telehealth communication, as outlined by researchers, include:
- Limiting user access to other device settings and applications, installing browser restrictions, and placing communication gadgets in “kiosk mode,” a feature available on iOS gadgets (guided access), Microsoft Surface (kiosk mode), and Android (screen pinning) (Fang et al., 2020).
- Ensuring the availability of pertinent telehealth communication technology and the proper positioning of cameras.
- Ensuring patient privacy by creating unique accounts for every client or selecting an application that authorizes calls from a sanctioned contact listing. Other approaches include disabling screenshots and video capture to prevent the storage of clients’ and practitioners’ details on the device (Fang et al., 2020).
- Promoting patients and workforce safety by proscribing health care workers from utilizing the free applications used to enhance patient-family communication. Clients must not have access to healthcare workers’ contact data, and providers should not be allowed to call the healthcare setting’s gadgets using their personal accounts (Wu et al., 2020). The configuration of relevant applications and device settings should also be done to prevent unauthorized downloads and settings changes (Fang et al., 2020).
- Enhancing the device’s usability by installing user-friendly communication applications. Examples of this software include KFSHRC PatientConnect and the National Guard Health Affairs.
Conclusion
The COVID-19 pandemic caused significant changes within the healthcare landscape, which currently affect communication between families, patients, and healthcare providers. Governmental restrictions to minimize SARS-CoV-2’s spread also limit PFCC practice. Many ICUs have shifted their clinical visitation and communication approach from the bedside and in-person discussions to remote interactions exclusively via video call or telephone to resolve this issue. However, despite the widespread telehealth utilization to facilitate communication, several barriers still hinder this strategy’s efficacy. Major identified themes are technical challenges, communication with healthcare teams, and a more intimate connection between families and patients.
References
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