Since the start of the Covid-19 crisis, more and more we have been required to use technology to stay in touch with the people we love and care about. Communication through different interfaces has become an even more essential part of our day to day lives. Could it be classed as an ‘occupation?’ It is after all a ‘meaningful activity’. Those weekly virtual quizzes or HouseParty drinks with our friends and family have for the last couple of months become ‘the norm’ and the way some of us are remaining occupied. Arguably, in doing so, it could be said we are deriving a sense of togetherness and ultimately ‘purpose’ via a virtual medium. It showcases occupation as both a means and as an end.
Being stripped of our ability to be face to face with one another has meant that we are seeking comfort and togetherness from a screen. For us, screen time conversations are a bit of fun and mean we can virtually transcend our living room and be with each other in a cloud based world, seated at a tablet.
But what about our patients in hospital? Since the pandemic, hospitals have stopped visiting to ensure safety and social distancing. Whilst this is an important and necessary directive, it nonetheless deprives our most vulnerable from being able to interact face to face with their loved ones. Whilst we might be in the same storm as our patients from a social distance perspective- being far removed from the people we love- we are definitely not in the same boat.
Hospital wards are busy. They are noisy, confusing, bright, clinical and uninviting. A far cry from the comfort of our cosy living rooms. What’s more, now that we are covered in PPE, our sense of humanity, touch and friendly smiles have been stripped from our patients when they absolutely need it the most. Doors are closed. People are sick. People are truly isolated, anchored to their chairs or beds until such time as when they can return home. This is social deprivation at its worst.
Before covid-19 arrived, as part of our Occupational Therapy sessions with patients, we would regularly involve carers, friends and family members to ensure they felt reassured and comforted by familiar people. This was the case particularly for our patients living with dementia, in a state of delirium or acute confusion. Being around people who would normally care for or support them meant that we were able to remain ‘person centred’ and engage this group of patients differently. We were able to encourage them to participate in rehabilitation with familiar faces, voices and possessions. It is honestly one of the most magical parts of being an Occupational Therapist when a patient who has been sitting in a chair in a hospital night gown, non-communicative and frail comes alive at seeing their relatives; putting on a pair of shoes and a cardigan; brushing their hair and walking to get themselves a cuppa or hug their grandchild. That is Occupational Therapy: finding what means something to someone and using it to help them find themselves again.
Now that we no longer have access to these resources, we are having to be creative with how we can motivate and engage patients who are otherwise lonely and frightened. Hospital staff are the only people patients will see for days or sometimes weeks. In normal circumstances this presents it’s own challenges, but now we are dealing with a virus that doesn’t care. Loneliness, depression, isolation and boredom are not conducive to rehabilitation and these secondary effects from ‘no visitation‘ are too spreading like a virus.
FaceTime can be a welcome remedy. Whilst it is of course not a panacea, it helps to solve the problem of unfamiliarity. Over the last 3 months or so I have been involved in facilitating virtual conversation between patients and their loved ones. It is humbling to witness. Whilst we are wearing face masks and visors, the screen allows patients to see the full face of people they know and love. They can see their smiles, their eyes, their facial expressions and the warmth and love that beams through the four corners of their handheld device. I become a bystander, an ‘other’ and an enabler in a whole other way than I have before. I am secondary to the screen and the interaction that is happening in front of me. I love it. It has been fascinating to work with elderly patients who have never used FaceTime or seen their relatives on a screen. They light up with surprise when their son or daughter pops up in front of them. They can hear words of encouragement and familiarity and experience a virtual esoteric sense of togetherness. It builds rapport and trust in a new way. Patients see that we care about them as people. As people with loved ones and as people with meaningful relationships behind that screen. Home becomes a reality- a virtual reality. Able to virtually walk through their homes or gardens and to see what they are working hard for to get back to. Once patients have spoken to family their demeanour changes. They want to get out of bed. They want to have a shower and sit out in a chair to have their breakfast or lunch. They visibly lift and are a step further away from that dehumanising gown that ’restrains’ and hides them. FaceTime becomes a tool for rehabilitation.
As NHS frontline workers and more importantly as Occupational Therapists, we must all make time for FaceTime so that we can bring patients together with their loved ones during this brutal pandemic that seeks to strip us all of our humanity and ability to be close. These patients who are fighting Covid-19, deprived of the little things that help them to feel ‘well’ need us to work creatively to keep a sense of home in their minds eye. Without visitors, without a hug from their spouse or touch of a hand from a caring friend, our patients are starved of comfort and tenderness from those they need it from the most. We have a responsibility to bring that to them in a small way so that they feel connected.
We can use our knowledge, skills and creativity to bring in to the hospital setting a ‘new’ form of communication for our patients. As Occupational Therapists we actively encourage people to communicate- to ensure their needs are met- and more than this: to ensure their voices are heard, that their wishes are respected and fundamentally that their wellbeing is at the heart of our intervention. Without having loved ones at their side in times of need, vulnerable patient voices become silent; drowned by clinical vernacular with an agenda of its own. It’s our responsibility and one of our specialist skills to promote ‘person-centred’ care. This act of bringing patients together with their virtual visitors goes further than just providing comfort. It actively is person centred. This is more than following a professional guideline- to say that we are meeting Royal College of Occupational Therapists (RCOT) requirements. By allowing a different mode of communication in to an otherwise disempowering scenario, our patients in hospital are given opportunity to collaborate with their loved ones and communicate in a way that ensures they are listened to. Decisions about going home, what care or equipment they need, for example and any concerns can be discussed collaboratively with people they trust.
My colleagues and I have used FaceTime to facilitate family meetings for complex discharges, show relatives pieces of equipment and during joint sessions so that patients can hear a familiar voice that jointly wills them to ‘stand up’. We have been able to see if someone’s cognitive or verbal presentation is ‘normal’ for them through digital interaction. There are no visiting hours; it’s a mode of communication that breaks down physical barriers. We can ask families to speak to their relatives who are confused about the time of day to wish them ‘goodnight‘. We can allow relatives to be at their most vulnerable and say ‘i love you’. What an absolute privilege to facilitate such intimacy that would normally be limited and time bound through ward visiting hours.
I have been fortunate to witness some wonderful moments with patients and their relatives through FaceTime. Most notably, helping a young man to shave after a long stay on ITU so that he would look familiar to his children. After not seeing them for over 3 weeks he wanted to remain their ‘Dad’ even through a digital interface. He initially was not keen on tending to his personal care and focussed on his mobility. However, when discussing his family and the prospect of supporting him to shave his beard so that his son and daughter would recognise him over FaceTime: his motivation changed.
One moment that will stay with me forever was shared with my friend and colleague Jane. Two elderly married patients were on separate Covid-19 wards and we were able to facilitate a FaceTime call between the two of them on site. They had never been parted for such a long period and it was a very special moment when they recognised one another on our devices and were able to say ‘i miss you’. This gentleman’s desire to see his wife far outweighed our agreed goal to enable him to walk and return to functional independence. Once spoken to her, he was calmer, reassured and trusted our further interventions.
The power of digital communication is not to be underestimated. Moreover, the ability to facilitate a simple conversation between relatives should not be overlooked as banal. We are using FaceTime as a means of lifting patients from the setting in which they find themselves; to remember they are a person with a story rich with ‘occupation‘ that they will be able to return to once their Covid-19 chapter ends.