key: cord-0800039-hbjlfrrt
authors: Pierce, Ayal; Hoffer, Megan; Marcinkowski, Bridget; Manfredi, Rita; Pourmand, Ali
title: Emergency department approach to spirituality care in the era of COVID-19
date: 2020-09-14
journal: Am J Emerg Med
DOI: 10.1016/j.ajem.2020.09.026
sha: 550def1be3c7bf12b2d2e2538454673f88711319
doc_id: 800039
cord_uid: hbjlfrrt

nan

In the era of COVID-19, physical distancing measures have been widely implemented to limit viral transmission. Hospitals across the world have restricted visitation except under extenuating circumstances. Under these conditions, many critically ill patients are treated without the comfort of loved ones at the bedside; this can have negative outcomes for both patients and their family.

An increasing focus on the intangible elements of patient care, including familial support and spiritual care, has led to the implementation of holistic patient-centered initiatives in many hospitals. A vast range of patient and family needs is seen in the emergency department (ED), where it is necessary for chaplains and spiritual care professionals to be incorporated into the patient care team 1-5 . Therefore, addressing the spiritual and psychological needs of patients and families has become critically important during this public health emergency. We present a simple two-pronged method that can be implemented in hospitals during extraordinary times, such as pandemics, to improve holistic care of patients and their families: Prong one involves immediate post-resuscitation care of the patient followed by care of the patient's family members who may be unable to be physically present and prong two involves utilizing hospital staff to facilitate direct communication with family when visitor restrictions are implemented.

After the death of a patient, some institutions have implemented a 30 second postresuscitation "pause" during which all members of the resuscitation team momentarily suspend all tasks and silence the monitors 6,7 Hospitals have implemented these pauses for three reasons.

First, it allows members of the team to honor and recognize the life of the patient. Second, there is recognition of the emergency team's collective effort to restore this patient's life, and third, it provides emergency clinicians the opportunity to psychologically transition from a resuscitation event back to routine functions. Our approach ( Figure 1 ) begins with this post-resuscitation pause not only to provide the aforementioned benefits, but to allow time to address spiritual and faith-based interventions on behalf of the patient and family. (Table 1) Rather than a simple moment of silence, this pause could be personalized by using the patient's name and acknowledging that a human being who was special to someone and productive in this world had just died in the presence of the resuscitation team. Furthermore, should the patient's spiritual or religious preference be known, a member of the team who has undergone prior training could include a 2-3 sentence contemplative testimony. This allows clinicians to provide spiritual care when physical limitations have been met. (Table 2) We also propose a non-pastoral spiritual care team, trained by chaplains and the palliative care department, lead the intervention (Figure 2 ). While these measures could be implemented quickly, training by these teams will equip hospital staff to feel comfortable addressing families and providing holistic end-of-life care on an emergent basis [8] [9] [10] [11] [12] . These staff can use multidisciplinary spiritual and faith-based interventions when chaplains are unavailable.

As the dynamic of medicine increasingly shifts to focus on a patient-centered model, the notion of family-centered care has gained traction as well. The American College of Critical Care Medicine outlines family-centered care as the ideal practice for end-of-life care 13 . In the J o u r n a l P r e -p r o o f Journal Pre-proof intensive care unit (ICU), family presence at the bedside is becoming a widely adopted tenet of care, as it has been linked to noteworthy benefits. Namely, family visitation in the ICU has been associated with a shorter length of stay, improved outcomes, and a decrease in anxiety and posttraumatic stress disorder 14 .

While patients and their families appreciate speaking to physicians, it is important to recognize and utilize the role of additional team members, particularly nurses and pastoral care providers 15-18 . Nurses often have some of the closest and most sustained contact with the patient and family, and families often find consolation in speaking with the patient's bedside nurse 19 .

Moreover, surveys have found that pastoral care providers perceive nurses as spiritual care providers 18 .

Moreover, there is evidence to support the use of telemedicine to connect chaplain and patient as well as chaplain and patient family members 20 . While the role of "tele-chaplains" has yet to be fully explored, many chaplains have incorporated electronic communication in other aspects of ministry and, thus, may feel comfortable with this format 20 . In the context of the patient's critical health status, tele-chaplains could pray remotely with patients and their families, an intervention that has proven to improve the quality of life for patients near death 21 . Team Leader Thank you everyone for your care of this patient. Before we go back to our busy job, let us take a moment to stop, thank, and honor this person's life. Before this moment, they were a person with a life, a story, and memories. Perhaps they were someone's partner, child, or parent. To those people, who cannot be physically present with us today, they just lost a world We should also recognize what we learned from them and thank them for the education they provided us. Although our medical interventions have been exhausted, let us honor who they were, their life, and their spirit, with 30 seconds of silence. J o u r n a l P r e -p r o o f

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