Distance Articles

Distancing in care, the accounts of nurses

The double challenge of building a relationship without human contact and while reinventing the way of working

Paola Di Giulio

University of Turin

By June 2020July 17th, 2020No Comments
Photo by Lorenzo De Simone

There are mainly two antithetical keywords that we will remember with this emergency: gathering and distancing. Distancing/isolation, physical and social, is the aspect that had the most devastating impact on everyone’s daily life. It also made us rethink several aspects of a profession that is founded on principles such as closeness and contact: using a “therapeutic touch” or holding a patient’s hand are gestures that can no longer take place during the Covid emergency. Distancing became a lifesaver, for assistance providers and patients alike. If just a few months ago someone had asked us to consider assisting a patient without physical contact and without gloves we would have said it was not possible and that it was wrong.

Usually we know rather well the enemies we are fighting everyday and, no matter how aggressive, they hardly stop us from living the totality of the relationship with our patients. However, this time it’s different, as Covid-19 made us face a greater and more professional challenge: trying to promote a relationship…that more than anything else aims to overcome a physical distance we are not used to. – Flora

The accounts of nurses are the focus of this article, where they talk about their experience with distancing. Their testimonies are taken from the interviews and diaries collected during this emergency that will be published on the Assistenza Infermieristica e Ricerca (Nursing Assistance and Research) journal.

The many forms of distance

The aspect that left a mark more than anything else was not being able to have a physical contact with the patient, not being able to enter rooms and communicate freely. Like Sebastiano wrote, “These days communication passes through that slit between the head cap and the facemask”. The additional difficulty was that there were not enough suits and masks to get changed in each time.

A context where caring became very challenging: difficult verbal communication, hindered by facemasks that distort the sound and the tone of our voice, and impossible non-verbal communication due to our face being completely covered by PPE. The only part you could see were the eyes, that were difficult for patients to discern, but most of all it was difficult to maintain any form of eye contact. Finally, a pair of gloves impeded touch. – Lucia

Many times we find ourselves unable to assist disoriented patients in the way we wish to… we find ourselves unable to move patients who can’t do so on their own, because putting them in a seated position on a chair or armchair requires a certain degree of supervision, which cannot be guaranteed given the closed doors and the limitations around entering rooms. We find ourselves saying: “Doctor, the patient seems to be getting worse.” The reply we get is often: “Do I need to go and see them immediately or can they resist a few hours until the doctor of the morning shift arrives? There’s only one suit left.” – Martina

I don’t even like to speak about how heartbreaking it is to see the loneliness of patients, isolated in their rooms, where the only opportunity for human contact is with individuals that are dressed just like workers of a nuclear power plant. – Martina

It became evident how important and powerful were a phone call or a video call in order to hear and see life outside. Phone calls and video calls virtually cancelled all the distances and became the only way to establish a contact between patients and relatives.

Helping them maintain contact with relatives became part of the work routine. We made sure that the call button was available, but also that the mobile phone, the only contact to the outside world, was reachable, charged and switched on. When taking the routine medical history information we would also ask for the pin code in case the telephone switched off. – Martina

Suits, masks and visors have created distances even in the gestures and procedures that would normally require close contact.

When you’re trying to draw blood and you’re looking for a spot in the mask that isn’t foggy so that you can see clearly from there, the first instinct you get is to tear out the goggles but you don’t do it because you know that, even though they’re a bit fogged up, they still protect you. – Mattia

They also created distances between those who were used to working closely together.

None of us was recognisable. The smile, the hair, nothing allowed you to recognise one another, not even the voice, as it was distorted by the PPE. You feel alone, once again. You have been reduced to the ink strokes on your back that spell out your name, nothing more. – Giacomo

Underneath the suit, mask and visor that we wear as armour we are actually as delicate as leaves. We only recognise one another thanks to the names written with a marker on our suit. Some of us personalises the writing with hearts, flowers or with reassuring statements (I often wondered whether these were meant for the patients or for us). – Giulia

For many nurses (and not just them) the pandemic transformed into choices that created other painful forms of distance.

Like many of our colleagues we haven’t seen our relatives and parents for a long time for fear of infecting them. We see them through video calls. Even though they are worried about us they don’t say anything other than, “Be careful”. There are so many unsaid words and emotions in those words. – Giulia

The pandemic changed the approach to work, emphasising the distance between a knowledge that developed day by day and a practice that required immediate answers.

We were always used to have a text, a scientific article or a guideline where we could find the answers to the questions emerging from clinical practice. This time there was nothing… We were forced to reinvent our approach and to adapt to the continuous evolution of the emergency. – Lucia

Conclusion

The Covid emergency shed light on the many weaknesses of the system, it brought us to redesign spaces and procedures in order to isolate and distance, sometimes playing it by ear. It left a mark on several nurses, on a personal level too. We are now slowly heading toward a new normality.

I will take with me and put in my baggage of experience every single thing I’ve learned this month. Wednesday I will start again my shift at the ward knowing that I won’t be the same nurse I was a month ago. – Ilenia

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