Strategies to humanize the medical treatments and mourning in
COVID-19 Intensive Care Units
The COVID-19 pandemic has modified many aspects of clinical practice. As
a consequence of the increased number of patients who have been admitted
to hospitals, the workload of Intensive care Units (ICUs) has augmented
drammatically.1-3 When the first wave of patients
arrived, many health-care workers had been taken by surprise. Although
the COVID-19 crisis is, primarily, a physical health crisis, in many
cases physicians understood the urgency of the mental aspects as well
and tried to find new ways to humanize the patients’ hospitalization.
Policies designed to keep patients and medical staff safe required
extreme but necessary measures, including social distancing. That meant
that patients were isolated from their families until discharge,
remaining in a sort of undefined mental space. The common question that
brought the patients’ relatives together was: is this really a temporary
separation or a start towards a final departure?4Sometimes patients asked for the opportunity to have a last farewell
using electronic devices or goodbye letters.
This sufferance was not exclusive
to patients and their relatives, but also to the health professionals.
COVID-19 presented the health care community with unprecedented
challenges and in the worst scenario the ICUs were saturated and there
were no free beds available. In this complex situation, simple acts of
kindness and empathy helped patients, families, and medical staff to
cope during these trying times.
While the advantages of modern technologies, such as smartphones or
laptops, helped reduce the emotional toll accompanying such sacrifices,
the protective devices used by the ICU teams resulted in
depersonalization and difficulties of communication, and caused a
profound sense of loneliness. In this complex scenario, the need of true
communication has been urgent, e.g. facial expressions, and physical
contact.
With these considerations in mind, two critical points can be made.
First, patients need time and human presence as part of their therapy.
This has been proven by the fact that good mental health facilitates the
recovery of patients by reducing anxiety, depression, and delirium that
are very common manifestations in COVID-19
patients.5-7 Second, more adequate communication
between the families and the medical staff, especially in cases of worst
prognoses, is necessary to facilitate and assist the process of
mourning. Social isolation during the COVID-19 outbreak, in fact, means
that family members may not be able to spend time with the dying person
in her/his final moments, and have to forego traditional funerals and
burials, therefore an un-elaborated grief remains. Someone might
experience feelings of guilt and anger.
Thus, the urgency of humanizing the ICUs is ever increasing in its
importance. Therefore, it is necessary to consider communication as a
critical skill of clinical care. In this context, communication cannot
be reduced to a simple exchange of information, but also involves an
important emotional responsibility. When communicating with patients and
patients’ families, physicians should describe the clinical conditions
in a comprehensive and clear way, without transmitting anxiety.
Attention should be paid to potential doubts, questions and feedback
given to the former.8
Furthermore, when patients are conscious, it would be better promoting
video-calls with their relatives. These approaches could offer mutual
and reciprocal benefits: patients will be less anxious, and their
families will have more time to accept the clinical condition of their
loved ones.
At the same time, non-pharmacological interventions, including guided
imagery, music therapy, and meditation, represent effective tools to be
adopted for humanizing the medical treatments. In fact, they have been
useful for alleviating pain, discomfort, and anxiety, while preventing
the risk of negative long-term effects, such as delirium, a common
symptom affecting COVID-19 patients after some days of hospitalization.9
Similarly, the same holds true for the medical staff who are working at
the forefront to counter this public health emergency for whom the
emotional workload and stress is stretching their resilience to the
utmost. Thus, cognitive-behavioral therapies, establishment of support
groups, and stress-reduction trainings, are important resources that
should be promoted for reducing emotional exhaustion and improving the
resiliency of the health-care professionals.
The COVID-19 pandemic has become a leading cause of death worldwide and
the loss and death pervade our lives. While these issues have often
represented taboos in western society, we now recognize the necessity to
educate people talking about end-life treatment. At the same time,
admissions into the ICUs are increasingly more stigmatized because of
its association with a high probability of death, sufferance and human
pain. Thus, the humanization of medical treatments should be a goal for
all physicians and, considering its importance for both patients and the
medical staff, it should be taught in all medical schools and become an
integral part of the education of our future physicians. Understanding
and addressing the aspects that contribute to the humanization of the
ICUs represent a critical point for delivering high-quality critical
care, enriching clinical practice, and improving the wellbeing of the
patients and their families.