key: cord-1028184-jccnlimd authors: Ohta, Ryuichi; Ikeda, Hirotaka; Sawa, Junpei title: The importance of patient-centered care during the COVID-19 pandemic: lessons from a rural ward in Japan date: 2021-04-01 journal: J Rural Med DOI: 10.2185/jrm.2020-045 sha: 31441409620978147e5b0cc83ee1061beaf99cee doc_id: 1028184 cord_uid: jccnlimd nan The COVID-19 pandemic of 2020 has emphasized the importance of patient-centered care and the value of the function of general physicians in the medical community. During the current pandemic, the work of healthcare professionals in Japan has been more challenging than usual, which has resulted in stress. COVID-19 was designated as an infectious disease by the Japanese government, and each prefecture must isolate and report all cases in medical institutions or in other facilities 1) , which substantially increases the burden of administration-related documentation for nurses, nurse supervisors, administrators, and state departments. Healthcare staff, patients, and their families are often stressed beyond the point of being able to control their emotions, which inevitably results in some conflict 2) . However, while caring for patients with COVID-19 during this chaotic time, it is important for rural medical staff to perform patient-centered care that evokes deep understanding and sympathy for patients and their families 3) . Our hospital began accommodating patients with CO-VID-19 in March 2020 after transforming a general hospital ward into a specialized isolation unit for these patients. The pandemic manifested suddenly in our prefecture, impacting unprepared medical institutions. Our hospital is located in a rural area and struggled to deal with the patient load due to a lack of healthcare resources. Most rural healthcare professionals were unfamiliar with managing specific infections. Additionally, our hospital staff struggled to develop flexible standards to accommodate patients with COVID-19. During this response planning process, many conflicts arose among citizens and hospital staff as well as with other institutions. In rural Japan, patients with COVID-19 feared that their medical status would be unintentionally disclosed to other community members and thus, were worried about the strong reactions against them 4) . Adverse reactions from the community have exacerbated the mental stress experienced by patients with COVID-19 and their families. Medical staff, overwhelmed by work and personal difficulties, have also shown negative feelings toward these patients. Patient-centered care is critical for solving various problems within medical institutions during this pandemic. Moderating such a challenging situation makes the discovery of common ground among healthcare professionals, patients, and families vital for the effective care of patients with CO-VID-19 5) . As healthcare professionals, our experiences during this pandemic are intense, and the fear of infection is reasonable. However, patients and their families experience many more challenges, not only from the disease but also from social isolation and segregation from one another and their communities 6, 7) . Sharing, understanding, and mitigating each other's physical and mental stress as a result of the COVID-19 pandemic are crucial 5) . In our setting, medical staff and affected patients engaged in frequent dialogue and information sharing via nursing calls and communication technologies, which enabled those affected to remain reasonably informed. To mitigate the potential negative impact on rural nurses in the COVID-19 ward, the nursing director and head nurse in the ward monitored the mental health status of staff members every week and alleviated the physical burden of work shifts 8) . Subsequent waves of this pandemic should be managed through various forms of information doi: 10.2185/jrm.2020-045 and communication technology (ICT), such as television communication tool, that help connect medical institutions with the outside world. In rural areas in Japan, older people are experiencing a lack of communication with their distant families because this pandemic has disrupted their families' travels to their hometowns 9) . ICT can support these aspects of their daily lives and help mitigate their isolation and feelings of loneliness. While the pandemic was still widespread, we received several letters from patients with COVID-19 at the time of their discharge (Figure 1 ). The letters consisted of cheerful comments and messages of gratitude to the nursing and medical care staff of the COVID-19 ward. We realized that our consistent dialogue with patients was perceived as sympathetic and compassionate by them. Despite their own medical concerns, they found the time to express their grati-tude to the healthcare professionals who treated them. Because of the vulnerability that patients with COVID-19 and their families face due to the severe health risks and associated social challenges, seeking common ground through persistent dialogue with patients is vital during this time 10) . When medical professionals, especially general physicians who are working on the frontlines, practice patient-centered care that involves expressing compassion and concern, they can greatly help in improving patient satisfaction and the holistic management of patients with COVID-19. It is taped to the translucent vinyl sheet from the inside a space contaminated by COVID-19. COVID-19 pandemic response in Japan: What is behind the initial flattening of the curve? Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic Defining "patient-centered medicine Challenges and solutions in the continuity of home care for rural older people: a thematic analysis Impact of the COVID-19 pandemic on the core functions of primary care: will the cure be worse than the disease? A qualitative interview study in Flemish GPs Stigmatization and prejudice during the COVID-19 pandemic COVID-19 and mental health: a review of the existing literature Overcoming the challenge of COVID-19: a grounded theory approach to rural nurses' experiences COVID-19 leads to physically severe experiences for the rural elderly in Japan, during Obon Impact of COVID-19 on the analytical diagnosing ability of family medicine residents We would like to thank everyone who participated in this research.