Enhancing the obstetrical patient’s experience during COVID-19

Author(s): Nicole Kirchhoffer, MSN, RN, CEN

In a busy New York City hospital obstetrical unit, I felt I was standing at the shoreline awaiting the COVID-19 tidal wave to come crashing down, grabbing our healthcare team by the ankles, pulling each of us underwater as we gasped for our final breaths. I knew I had to act fast because without a motivated and engaged team, a positive patient experience would be difficult to achieve.

Patient experience is a major concern and priority among hospital leaders.

What would we be contending with during and after a global pandemic? Would the same improvement strategies work? The answer is still unknown because we are currently in the thick of COVID-19 and will be for the foreseeable future. However, it’s no secret that nurses directly affect the patient’s experience and will continue to do so during this health crisis.

For nurses to promote a positive patient experience, they need leaders to support them, be present, and listen to their concerns. This reduces cynicism among staff, increases engagement, and is paramount in helping build relationships. There is no better way to say to staff I care about you than being present and working side by side with them.

With a heightened level of anxiety and fear experienced among patients and staff alike caused by COVID-19, we are relying heavily on our nurses to provide additional emotional support to our patients. During this time of social distancing, there has been a lot of emphases placed on making meaningful connections with one another to create a sense of connectivity and belonging. Establishing relationships with patients enhances patients’ perspective on their quality of care, increases staff resilience, and prevents burnout.

Ensuring each patient’s hospital visit is positive and remains seamless under ordinary circumstances is no small responsibility, let alone during a historic global health crisis. Before entering the hospital, most patients have some idea of how their hospital stay should be or how they would like it to be, through the countless pregnancy blogs, discussions with friends or family members. Obstetrical patients are highly knowledgeable on what to expect before their hospital visit.

Many obstetrical patients have never had an inpatient hospital stay before delivering their baby, so they tend to compare their stay to other experiences, one being a hotel. This unfair comparison puts hospitals at a disadvantage when competing with the expectation of a hotel, however, using our strengths, such as providing empathetic care, sets us apart from other industries and competing hospitals even during a historic pandemic.

Even within a hospital, a dichotomy exists between obstetrics and the other hospital departments because of the differences in our patient populations. For example, our patients are generally healthier and younger than those in other service lines such as medicine. Hospitalization is expected by obstetrical patients and anticipated for many weeks and months, unlike other departments where most patients enter the healthcare system through the emergency department. Expectant mothers typically ponder their birth plan and deliberate on whether or not to have any medical interventions for pain management, such as an epidural, or to labor naturally without any labor-inducing medications. In addition, they are now faced with the reality that most of their loved ones are not allowed in the hospital during one of their life’s milestones.

The obstetrical patient’s family and friends are necessary for promoting a positive experience and are an important part of the care team to help foster the patient’s recovery after childbirth. With current visitor restriction guidelines, obstetrical patients are only allowed one healthy adult visitor. This can pose a challenge for our patients who have other small children at home and rely on their significant other to care for them while they’re in the hospital. I’ve learned through my patient experience journey that you may not always have all of the answers or know the right thing to say; however, sometimes just your presence and listening is all that is needed. Here’s an example of that:

As I knock on the door to enter the room, the patient waves for me to come in, I notice she is on Facetime with her school-aged child who says, “Mommy, I miss you, when are you coming home?” as the mother puts on a brave face and holds back her tears, I can truly empathize with her because I also know what it’s like not to hold my 7-year-old (45 days and counting as I’m writing this). As she says goodbye to her child, “Mommy will be home tomorrow, I love you”, and hangs up the phone, she releases a flood of tears. I introduce myself and pull up a chair, then just sit there and listen as she continues to cry and says, “I just miss him so much, this is so unfair, I couldn’t wait for my son to come up to the hospital and meet his new baby sister.” Agreeing with her I say, “I understand why you are feeling upset, it is unfair.”

The patient understands the rationale for why children are restricted to visit, but the circumstances are unfair, as are the many moments so many of us have lost. The patient dries her eyes and thanks me for listening. I reply, “No need to thank me, we are experiencing this together.”

Empathy is often described as putting yourself in someone else’s shoes. This concept is vital in healthcare because it helps you understand what your patients are experiencing through their perspective. The pandemic is something we all couldn’t have imagined, but it has brought us closer. We are living through this together and have all experienced some form of grief, whether it’s loss of a job or the inability to celebrate a milestone in the traditional way. Our normal way of life, before COVID-19, has slipped away and because we have a shared understanding, many of us are even more empathetic because of it.

Effective, proactive, and non-verbal communication such as listening is essential in providing high-quality care to patients and has proven to be the key component in ensuring a positive experience for our obstetrical patients during COVID-19. In a fast-paced, resource-stretched hospital, being available, present, and listening for a few minutes can help us connect with both our patients and staff.

Nicole Kirchhoffer is the nursing service excellence manager at Maimonides Medical Center in New York.

References

Hermann RM, Long E, Trotta RL, Improving patients’ experiences communicating with nurses and providers in the emergency department. J Emerg Nurs. 2019;45(5):523-30.

Maguire P, Pitceathly C. Key communication skills and how to acquire them. BMJ. 2002; 325(7366):697-700.

Mckenna KM, Hashimoto DA, Maguire MS, et al. The missing link. Acad Med. 2016;91(9):1197-99.

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