This blog post aims to clarify how the clinicians on one Consultation Liaison (CL) Psychiatric Service communicate with general hospital inpatients who are being nursed in isolation during the COVID-19 pandemic.
Why?
There has been some confusion re nomenclature of how we provide mental health assessment/support to hospitalised people in isolation . Hopefully by describing the pros and cons of the methods we’ve tried to date we’ll clear-up any misunderstandings.
1. Videoconference Review
ie: using an online videoconferencing platform that works on both the clinician’s computer and the patient’s own device
Pros:
- No risk of infection transmission
- When it works there is reasonably good eye contact and exchange of facial expressions and other non-verbal communications, leading to opportunities for engagement/establishing rapport
- Since mid-late 2020, nearly all clinicians and many (most?) consumers are familiar with videoconferencing
Cons:
- In my clinical practice videoconferencing for these reviews has been mostly unsuccessful. Cross-platform incompatibility and limitations to what the devices/bandwidth that hospital inpatients in isolation have access to have been problematic.
- At our end, clinical workplaces do not provide access to the same platforms our patients typically use (eg: FaceTime, Video Chat on Facebook or WhatsApp).
- The technology was getting in the way of the therapeutic relationship, not enhancing it.
- For these reasons, we pretty-much gave up on trying to videoconference hospital inpatients in isolation back in April/May 2020.
2. In-Room Review
ie: in full PPE – face mask, goggles/face shield, gown and gloves
Pros:
- Physical proximity is standard practice: Clinical staff and the people we care for are familiar with this
- Reasonably good eye contact and partial exchange of non-verbal communication, leading to opportunities for engagement/establishing rapport
Cons:
- PPE obscures facial expressions, thereby inhibiting rapport/assessment
- An extra clinician(s) using PPE resources
- With no disrespect to my CLPS clinical colleagues, we’re generally not as well-drilled with donning and doffing as the specialist nursing and medical teams, creating potential risk of infection transmission
3. Face-To-Face Review
ie: through the window/glass door panel, using phones for easy/clear auditory communication
Pros:
- Good eye contact and exchange of facial expressions and other non-verbal communication, leading to opportunities for engagement/establishing rapport
- No risk of infection transmission
- Low-tech, easy to organise
- Well received by nearly every hospitalised person in isolation that my team has seen from March 2020 to August 2021
Cons:
- Reminds me of prison-visit scenes in American movies
4. Phone Review
ie: speak to the person on their personal mobile or bedside phone, no visual contact
Pros:
- No risk of infection transmission
- Low-tech, easy to organise
- It’s the go-to method of communication for community mental health intake clinicians/services (ie: thought to be a good-enough tool for most triage and sub-acute presentations; may be familiar to the clinician or consumer)
- Some people find emotional expression easier without the intimacy/intrusion of eye contact
Cons:
- Assessment and rapport may be limited
- Not thought to be adequate for acute or high-risk presentations
And The Winner Is…
Number 3: Face-To-Face Reviews, ie: where the clinician and person in isolation chat through the window/glass door panel, using phones for easy/clear auditory communication.
It’s cheap, easy and effective. We use it nearly every time when there’s someone in a negative-pressure/isolation room. We’ve saved dozens, maybe hundreds, sets of PPE, and we’ve reduced the likelihood of becoming potential super-spreaders.
Why Does It Matter?
Like just-about every other specialist mental health nurse on the planet, my clinical practice is influenced by Hildegard Peplau. Back in the 1950s dear old Aunty Hildegard had the audacity to tell nurses that, done right, the nurse-patient relationship = therapy [source]. About 60 years later neuroscience caught up with nursing theory and showed us that Peplau was right: strong relationships and strong attachments help brains heal by building new neural pathways [source].
A specialist mental health nurse is, amongst other things, a psychotherapist and a relationship focussed therapist [source]. A face-to-face review, even if has to be through glass, helps establish rapport and build a therapeutic relationship.
CLovid Acknowledgements
Consultation Liaison Psychiatry Service is a bit of a mouthful, so it’s usually abbreviated to “CL”. CL = mental health in the general hospital.
Back in March 2020 John Forster, a CL Nurse in Melbourne, accidentally coined the portmanteau “CLovid” by combining “CL” and “covid” as a typo.
That’s why I’m calling this blog post “CLovid Communication”.
Please forgive people like me who take delight in silly things like an accidental neologism. There’s been a fair bit of CLovid in the last eighteen months, and there’s more to come. Staying vigilant to the small joys and moments of lightheartedness is a survival skill.
Thanks also to Jelena Botha, CL CNC (who arrived on my team just in time for the global pandemic 😳), for allowing me to use her PPE pic.
Further Reading
Cozolino, L. (2006/2014) The Neuroscience of Human Relationships: Attachment and the Developing Social Brain. New York, W. W. Norton & Company. [Google Books]
Hurley, J. and Lakeman, R. (2021), Making the case for clinical mental health nurses to break their silence on the healing they create: A critical discussion. International Journal of Mental Health Nursing, 30(2): 574-582. https://doi.org/10.1111/inm.12836
Peplau, H. (1952/1991) Interpersonal relations in nursing. New York: Putnam. [Google Books]
Santangelo, P., Procter, N. and Fassett, D. (2018), Seeking and defining the ‘special’ in specialist mental health nursing: A theoretical construct. International Journal of Mental Health Nursing, 27(1): 267-275. https://doi.org/10.1111/inm.12317
End
What have I missed from this description of CLovid communication? Please add your on-the-job experiences and lessons in the comments section below.
Paul McNamara, 14 August 2021
Short URL meta4RN.com/CLovid
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