The Critical Issue of Covid-19 Testing in Hospice Care. Free Essay

I hope to solve the problem: the lack of patient testing for COVID-19 before they are admitted to hospice care. This problem makes it hard for health practitioners in the hospice environment to determine the patient's level of care. I am a registered nurse working in a hospice environment (Wallace et al., 2020). I work in a unit where patients are admitted without proper COVID-19 tests, and this has placed many of the other patients and health workers at risk of getting infected with the coronavirus which has currently become a significant menace to the healthcare industry worldwide. Many patients enroll in hospice care when they have terminal illnesses and are close to their deaths. It creates a necessity for COVID-19 testing of both the patients and the health care workers to avoid further infections and reduce the time remaining before their death.

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COVID-19 patients require special care in hospice environments because their health conditions are worse than those of the other patients in their last moments before death. Therefore, my unit finds a need to introduce screening and testing of all patients before they are admitted to hospice organizations (Wallace et al., 2020). This will help differentiate those infected from the uninfected ones and plan for specialized care for COVID-19 patients, especially in the ICU, where they are placed under oxygen.

2. Investigation of the Problem

I have chosen five patients and their families that I interview and ask about their thoughts on testing hospice patients under my care for COVID-19 before they are admitted to the health center. Three of the families I interviewed felt that testing patients for the disease before gaining access to the facility would play a significant role in keeping everyone safe. They also explained that those found positive for the coronavirus should not be restricted from accessing healthcare services in the hospice facilities. Instead, they should be admitted and placed under special treatment.

Some recent studies about the disease show that patients, especially those who avail themselves in hospice environments, should be admitted to the ICU and placed under enough supply of Oxygen using life support machines. In a study cited in the Centers for Disease Control and Prevention, the COVID-19 pandemic has one of the most heartbreaking consequences. People are dying in hospitals as they are hooked to life-saving machines. However, for those who do not want to go through extraordinary measures to save their lives, hospice is a better way to ensure they get a gentler end (Centers for Disease Control and Prevention, 2019). In the chaos caused by the pandemic, the hospice care industry is facing a significant threat as it is unable to meet the needs of its patients. Testing all patients in hospices for COVID-19 will help the healthcare providers decide on the protective gear to use, and how they will separate patients depending on their health status and the type of treatment, they are expected to receive.

Our hospice care has a policy of treating COVID-19 patients differently from those who are not infected to reduce the chances of fast death. I have had an opportunity to work in the section where such patients are admitted. Through interactions with other health providers and patients’ relatives, I realized a need to review our policies (CDC, 2019). Therefore, I reviewed our patient admission policy, which helped me determine the parts that needed to be modified.

The Leading Age believes that hospice providers should learn different styles to control COVID-19 infections. Other hospices in my unit had legitimate concerns about the chances of visitors, patients, and health workers being at risk of getting infected with the disease; hence better policies were required to reduce the chances of infection with the coronavirus (LeadingAge, 2020). Concerns mentioned included: COVID-19 testing of everyone at the gate before being allowed into the premises, isolation of all positive patients, and transmission-based precautions to reduce infection cases.

3. State of the situation using Current Data

Lack of necessary equipment and inconsiderate nurses have been significant contributors to the current problem in the hospice environment. Many nurses are known to be rude, and for the few cases of COVID-19 reported at the gate, there have been increased complaints of them being rejected entry, forcing them to search for care elsewhere (Parker, 2020). Some nurses in my unit feel that COVID-19 patients should not be treated; instead, they should be sent back home to die. Due to the limited resources to deal with the positive cases reported, a large percentage of the nurses have strongly presented it as a waste of resources caring for the COVID-19 patients from the premises. I have witnessed this with many nurses, and this has left many patients frightened of getting tested because they will be kicked out when they are found positive.

4. Solution for the Problem

Despite all the criticism presented by nurses against COVID-19 patients, I have seen a 75-year-old patient with the disease get adequate treatment in my unit and released after recovering with no severe complications. The interviews with fellow nurses, unit managers, and patients’ relatives have made me create a recommendation to begin testing all patients and visitors at the gate for COVID-19 and admitting those found positive for specialized care in the ICU and away from the other patients. A large percentage of the staff agreed with my proposal, arguing that it will help reduce cases of COVID-19 in hospice care. To facilitate this change, I suggest that the management purchase more equipment to test patients and protective gear for the nurses who will care for them. I also recommend training some nurses to deal with COVID-19 patients and creating an isolation center in the premises that will allow only chosen nurses to care for such patients.

5. Resources to implement the Proposed Solution

The hospice care premises will incur a lot of costs training many nurses to handle the patients tested positive for COVID 19. Other costs will include setting aside an isolation center with enough beds for all positive patients and purchasing testing kits and protective gear for all trained nurses. The unit managers and the nurses dealing with the positive patients will have their monthly allowances increased due to the risks they are placing themselves and their families in as they care for such patients.

6. Timeline for implementation based on Proposal

Planning for the project will begin in August 2020. Surveys and interviews will be conducted, and the results noted by the end of September the same year. Data analysis of the results acquired will be analyzed and reviewed by October 30th. The policy that was proposed will be presented to the management of the hospice by November 15. The revisions for the plan will be submitted by November 30th. The final draft will be presented by December 15th, and all staff will be given two weeks to prepare for the new admission style of all patients. January 1st, 2021, will be when all activities start running as per the approved plan.

7. Key Stakeholders important for the implementation of the Solution

I spoke with hospice nurses and my unit manager about the policy implementation I wanted to be included, and all of them were okay with it. Hospice nurses worked in both the patients' homes and inpatient units, and each of these environments had their advantages and disadvantages (Parker, 2020). All the workers in my unit experienced patients dying more times than their nurse colleagues. Despite some hospice patients getting better and going back home, a larger percentage of them died in the care of the hospice registered nurses. More people across the world experienced the vast benefits that my hospice providers had to their loved ones when facing death.

COVID-19 has affected all the aspects of hospice operations, personnel, and care that they provide to their patients (Magazine, 2020). Things have changed a lot in my unit with the formulation of new regulations that address hospice patients' virtual and telehealth visits. I involved hospice physicians, nurses, and assistant nurses because they have to adapt to the functional changes that have been brought by the coronavirus pandemic. Some concerns that arose include some nurses violating the proposed policy, an increase in infection risks, and lack of isolation centers with enough beds. The nursing staff was reminded that they had to ensure they continue providing services that comply with the Centers for Medicare and Medicaid Services (CMS) requirements.

Working with the Key Stakeholders to Achieve Success

Hospice nurses, unit managers, and the nurses in ICU will be the critical stakeholders for the success of this policy. The unit managers will be the ones to decide whether this policy is achievable or not. I will pass all the research and results acquired to the unit managers, and after analyzing everything, they will propose areas for change and correction. After getting approval from the managers, I will move on to the nurses and present the proposal to them, giving all details of how we expect to achieve the set goals. After coming into a consensus with the nurses and making final concerns and changes, I will present the policy to my unit manager for final approval and later ensure that all nurses adopt and start following the new set of rules.

8. How the Implementation will be evaluated for Success

Questionnaires will be sent to the patients’ relatives where they will be expected to answer various questions about the effectiveness of testing all patients for COVID 19 before they are admitted to assess the policy's success. The feedback received will be used to formulate necessary changes that will make the policy more successful. During staff meetings, all nurses will be asked to share their experiences with the policy and implement any changes.

9. Fulfillment of Various Roles during the development of the Proposal

I was a scientist because I researched and evaluated data from interviews and secondary sources. I used the results to give an insight into the problem and how it can be solved. I was a detective because I investigated the problem in my unit of work and used the issues to develop a change in how hospice nurses dealt with COVID-19 patients. I was a manager of the healing environment because I created a policy that will change how COVID-19 patients are treated in hospice care.

References

Centers for Disease Control and Prevention. (2019). Healthcare facilities: managing operations during the COVID-19 pandemic.USA.gov. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-hcf.html

LeadingAge. (2020). COVID-19: how should hospice providers control infection? Leadingage.org. https://leadingage.org/sites/default/files/Hospice%20infection%20control%20and%20visitor%20guidance%20311.pdf.

Magazine, C. (2020).Palliative care considerations for patients with cardiovascular disease under COVID-19.American College of Cardiology. https://www.acc.org/latest-in-cardiology/articles/2020/04/09/12/42/palliative-care-considerations-for-patients-with-cardiovascular-disease-under-coronavirus-disease-2019-covid-19.

Parker, J. (2020).CMS waives hospice physical environment/life safety rules during COVID-19. Hospice News. https://hospicenews.com/2020/05/11/cms-waives-physical-environment-life-safety-rules-during-covid-19/

Wallace, C. L., Wladkowski, S. P., Gibson, A., & White, P. (2020). Grief during the COVID-19 pandemic: considerations for palliative care providers. Journal of Pain and Symptom Management. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7153515/pdf/main.pdf