Providing Care During COVID

On Monday, Dr David Kenneth Wright spoke during the “FREE WEBINAR SERIES for PSWs about providing care during COVID. I was touched by the stories he shared, by the points that he made, and by the responses/input from those who attended.

Near the end of his presentation he said and asked, “COVID-19 has changed so much in the world, but what should it NOT change?” Participants responded:

  • Love and respect for each other
  • Our level of empathy and kindness
  • Compassion and care
  • Care providers dignity and respect

I am inspired by their spontaneous thoughts. I agree, that DURING COVID we should KEEP our compassion, care and concern.

Then I reflected on the things that changed during COVID that I WANT TO KEEP AFTER COVID. The first two that come to mind are:

  • Doctor appointments online
  • A slower, gentler calendar

Then I reflected on the things that I can’t wait to change after COVID. My first three thoughts are:

  • Hugs – giving hugs, long hugs, group hugs, strangle hold hugs, happy hugs, sad hugs… hugs with people I know and hugs with strangers
  • Seeing, being with, hugging and holding grandkids!
  • Gatherings with more than our bubble – in fact, a bubble bath of bubbles and friends, a dance with CCR, and a pot luck feast.

What are the things that you want to keep now, during COVID? What are the things that you want to keep AFTER COVID? What are the things that you can’t wait to change?

Have a great day!

Grief during COVID

In an article titled, “There is no vaccine for grief” Maxine Rattner and Marney Thompson write, “While grief itself isn’t a mental-health condition, unsupported grief can turn into one, such as depression and suicidal thinking. And due to the circumstances of COVID, the risk is far higher that grief won’t be supported.” 

Andrea Warnick

 

Andrea Warnick, an educator, registered psychotherapist, nurse and thanatologist was interviewed about grief during COVID on Canada Talks. She describes the challenge to convince people to take the space to grieve – to make space for the difficult feelings. And she emphasized the importance of allowing oneself to  have those difficult feelings. She stressed the importance that even during, perhaps especially during COVID, that people need to connect, share stories, invite stories,… even if we can only do so  online.

The Canadian Grief Alliance has called on the federal government to identify the gaps, the best practices, to develop a national public awareness campaign to help people know about loss, grief and to learn what tends to be helpful/not helpful. In Canada there has been an increase in funding for mental health during covid, but there is a great need for grief specific funding, Some of the strategies for mental health issues do not apply to those who are grieving. For example, “thinking positive thoughts” may not be the best strategy when one needs to find space to cry and allow sadness. 

“Never in our lifetimes has Canada experienced the volume and complexity of grief as has resulted from the COVID-19 pandemic.

(Canadian Grief Alliance)

Canadians have been robbed of goodbyes with dying friends and family or people they care about and forced to grieve in isolation without funeral rites. They and those working on the front lines of health care are at heightened risk for prolonged, complicated grief marked by depression, and the risk of suicide. Existing grief services are fragmented, under-funded and insufficient. Left unaddressed, significant long-term social, health and economic impacts will result.” Canadian Grief Alliance

What are your thoughts on this? How have you seen COVID affect grief in your lives and community?

Remembering Strategies for Safe Opioid Use

safe opioid use in the midst of the opioid crisis

Managing pain and dyspnea for people with life limiting illnesses requires safe opioid use. Dyspnea is one of the most common symptom experienced by people with COVID-19, so this is a good time to review safe strategies for using opioids.

Opioid misuse can be minimized by using risk assessment tools, contracts for opioid use, and following guidelines for safe storage and disposal. The following are examples of tools you might see or use to support safe use.

Risk Assessment Tools

When a pain or dyspnea assessment indicates the need for opioids for symptom management, a risk assessment tool can be used to help to identify those people who are more likely to struggle or be struggling with addiction issues. Identifying these people before beginning opioids can help the health care team safely manage their opioid use.

Four standardized tools are available at the website http://Opioidrisk.com. The tools vary from a 1 minute self-report to a 5 minute interview tool, offering a range of ways to assess the risk of opioid misuse.

Tell us about the tools that you use in your location. How are they different? Please post into the comments section, if possible.

Contracts and Agreements for Safe Opioid Use

Part of process for initiating opioids could include the discussion and signing of a contract, clearly outlining the person’s responsibilities for safe opioid use, including storage and disposal of medications. The contract facilitates the discussion around safe opioid use and will help establish the parameters required for safe opioid use in the home.

What types of contracts or users agreements for opioid use are you familiar with? Are they used before beginning opioids? Please add your document/contract or link it into the comments here. It would be interesting to see what is used for ensuring safe opioid use in different locations in Canada and the USA.

Tell us your thoughts on this contract linked here. Which parts are helpful and which parts don’t you like?

Sample User Agreement

Guidelines for Prescribing Opioids for Chronic Pain

2017 Canadian Guidelines for Opioid Use for Chronic Pain

Opioids -How to Use Them Safely

Guidelines for Storage and Disposal

Completing a risk assessment and contract with the person receiving the opioids can help facilitate safe opioid use. Including the following key steps (from www.healthcareprovidersolutions.com) when handling opioids will help decrease the risk of misuse and diversion:

  • Counting controlled substances at each visit for each patient, regardless of the risk of diversion in their home.  This practice is helpful for many reasons not just identification of possible diversion but may help to identify diversion early.

  • Limiting the supply of controlled substances.  In situations where diversion is known or suspected, daily deliveries of the controlled substances needed by the patient may be made or limiting the supply to just a couple of days is implemented.

  • Limiting access to the controlled substances.  This may be in the form of a lock box in the patient’s home with only certain individuals and hospice staff having access.

  • Working with the patient and family to relocate the patient to a more controlled environment such as a nursing home or hospice inpatient unit.

Health care providers need to know how to safely dispose of opioids. The following are guidelines developed for health care providers in the USA for disposing of opioids. Check for specific policies and procedures at your location.

Resources for Safe Opioid Use by Health Care Professionals and Family

Institute for Safe Medication Practices Canada – Opioid Stewardship – Brochures and downloads available

Fraser Health: Principles of Opioid Management – with specifics of safe handling and disposal of fentanyl patches

Four Strategies for Managing Opioid Side Effects

Strategies for Harm Reduction

Implementing any of these strategies for harm reduction may be helpful in reducing the current opioid crisis. Consider how to respond to people experiencing addiction with compassion and to support them in their rights to equal health care.

Canadian Nurses Association – Harm Reduction

BC Nurses Union – Position Statement on Harm Reduction

Compassionate Care for People with Addictions

Update of blog originally published in 2017