Balancing Infection Prevention with Human Connection: Exploring the Experiences of COVID Patients, Caregivers, and Care Providers with Acute Care and Inpatient Rehabilitation

Introduction: Healthcare facilities including rehabilitation hospitals adopted restrictive visitor policies as a result of the COVID-19 (COVID) pandemic. Despite catastrophes like the COVID pandemic crystallizing the importance of human connections, providing quality care and enabling human connection became incompatible with the infection control measures needed to promote patient, family, and healthcare provider (HCP) safety. Though these measures were necessary, they led to isolation and loneliness amongst inpatients that undermined their rehabilitation and recovery. One ubiquitous response to visitor restrictions was the rapid and widespread use of technology to overcome the challenges of not having family at the bedside. Little is known about how human connection was maintained across acute and rehabilitation care settings while infection prevention and control measures were in place.

Objectives: To explore the experiences of patients, caregivers, and HCPs with COVID care across acute and rehabilitation settings. Specifically, our goal was to understand how these stakeholders maintained human connections and relationships in the context of COVID infection prevention and control measures.

Methods: A qualitative descriptive study was conducted. Patients and their family caregivers were recruited from an inpatient COVID rehabilitation hospital and HCPs from either an acute or inpatient rehabilitation COVID unit. All participants were interviewed between August 2020 and February 2021.

Findings: A total of 10 patients, 5 family members, and 12 healthcare providers were interviewed. Three major themes were identified: Theme 1) Physical distancing helped prevent COVID spread, but precipitated social isolation and loneliness that was experienced across patients, caregivers, and healthcare providers. Visitor restrictions were difficult for patients and families who were separated for prolonged periods. HCPs isolated from loved ones due to fears of spreading COVID to them. Theme 2) Fear of COVID infection led to stigma that made people feel socially excluded. Patients and caregivers experienced stigmatizing behavior from family and friends in the community. HCPs experienced stigma by virtue of working in a healthcare setting. Theme 3) Technology emerged as the best available tool to overcome the consequences of physical distancing in order to facilitate human connection. Videoconferencing and phone calls helped patients and caregivers remain connected and aided HCPs in connecting with their loved ones.

Conclusion & Implications: Strict infection control policies in acute and rehabilitation hospitals resulted in loneliness and isolation among patients, their family, and healthcare providers that was mitigated by technological innovation and exacerbated by COVID-related stigma. Results from this study underscore the need to carefully balance the safety measures needed to mitigate COVID spread with the need for human connection across acute and rehabilitation settings and beyond the patient-provider dyad."