Taking Care of the Caretakers in the COVID-19 Era

Across the globe, health care professionals are rushing to the bedside of critically ill patients, risking their own well-being and testing their resilience as the COVID-19 contagion spreads. As a result, those health care workers are being forced to spend unprecedented hours inside medical facilities, whether in traditional hospitals or at alternative sites that have been converted into makeshift coronavirus care centers.

And their Herculean efforts lead to one important question: As they are rushing in to take care of many of us, who is caring for all of them?

And their Herculean efforts lead to one important question: As they are rushing in to take care of many of us, who is caring for all of them?

The answer may lie in how we consider the impact of these medical environments on the well-being of health care personnel, and how we incorporate key design and operational elements to reduce burnout and enable a more resilient health care team.

We know health care providers can be both carriers and victims of COVID19. We also know that even before COVID-19, up to one-half of physicians and one-third of nurses experience burnout. In our attempts to provide access to intensive care unit (ICU) beds and ventilators, we acknowledge that teams of physicians and experienced critical care nurses will be needed to staff them. We need to create spaces that keep them safe and protect their physical and emotional well-being.

The first step

Initial design efforts should address the personal needs of care team members and their social or familial supports at home. Health care systems can establish access to centers that support the care of health workers’ children as well as their aging adult family members, including day care centers and places for pets. Knowing that their families are safely cared for would reduce stress and allow health workers to better focus on caring for patients. In the hospital, spaces should also be provided to support nursing mothers including lactation rooms, hand washing sinks and milk storage areas.

There is a real concern among many health care providers that their return home will mean exposing their families to the coronavirus. As they move from patient bedside to home, nurses will peel away layers of protective personal equipment (PPE) and wash the virus from their skin to reduce the risk of transferring the virus to others. In a busy patient care floor, spaces outside each patient room should be provided to remove PPE used for each critically ill patient. Best practice indicates that PPE should be changed between patients or removed before leaving the patient’s room. In some hospitals masks, shoe covers and gowns are also worn in patient care areas, near nursing work zones and in hallways. If PPE is worn on the patient care unit outside of a patient’s room, separate spaces are also needed to remove PPE before the worker leaves the patient care unit.

For some staff, the fear that they might infect family members is so great that they may prefer temporary housing near the facility they support. These temporary spaces should maintain the same privacy and security as a home would provide.

Taking a break 

Long hours of caring for critically ill patients is rigorous work and health care teams will need breaks during their shifts. Creating spaces for them to step away from the patient’s bedside allows staff to recuperate from the intense pressures of patient care.

These staff respite areas help team members recharge so they can be at their best physically, mentally and emotionally. Developing these types of spaces away from patient care areas with key elements, including access to daylight and views of nature, soft lighting, comfortable seating, soothing paint colors, and art provide much needed distractions from the burden of COVID-19 care. Space can also be allocated to support the spiritual needs of staff such as a chapel or meditation space.

Designers and organizers should also consider creating off-stage spaces where health care teams can eat a nutritious meal or snack. Hydration stations can alleviate thirst spurred by long hours wearing masks and hot personal protective gowns.

Working as a team

COVID-19 care workers operate much like members of a sports team. Doctors, nurses, respiratory therapists and others work together to save lives as an inter-professional team. COVID-19 care should be delivered in an environment that supports good visibility between team members as well as space to collaborate or share new best practices.

Before leaving the hospital, nurses and other health professionals will want to scrub away as much of the virus as possible. To avoid carrying the virus beyond the hospital floor, facilities should provide private spaces to remove scrubs, shower facilities and private dressing rooms to change into street clothes.

Access to a laundry area will be important to prevent staff from cross contaminating their clean clothing or their cars. Hospital leadership can work with their dietary staff or local grocery markets to provide a grab and go grocery spot for staff. These small grocery areas can reduce the need to go shopping after a long shift. This could be especially helpful in those communities where grocery stores may have limited operating hours making access to food a challenge for shift workers.

Preserving our health resources through the COVID-19 pandemic is essential to defeating it. And the most important resources of all are the very the people who care for us.