Family caregivers as essential partners in care: examining the impacts of restrictive acute care visiting policies during the COVID-19 pandemic in Canada.

INTRODUCTION: During the pandemic many Canadian hospitals made significant changes to their 'open family presence' and 'visitor policies' to reduce the spread of COVID-19 by instituting restrictive or 'zero visiting' policies in healthcare facilities. These policies have the potential to create great hardship, anxiety and stress for patients, families, caregivers and frontline healthcare providers (HCPs); along with concerns about the quality and safety of patient care. The presence of family members and other caregivers as essential partners in care is an explicit expression of the philosophy of patient- and family-centred care (PFCC) in action. The purpose of this study is to increase our understanding of how changes to family presence and visiting policies and practices during the COVID-19 pandemic have impacted patients, family caregivers and frontline healthcare providers (HCPs) in acute care hospitals. METHODS: A total of 38 in-depth semi-structured interviews were conducted with patients, family caregivers and HCPs in Canadian provinces who had experience with visiting policies in acute care settings during the pandemic. COVID patients, and the caregivers of COVID patients, were excluded from this study. A maximum variation sampling strategy was used to guide the selection and recruitment of patients, family caregivers and HCPs, based on our interest in gaining a diversity of perspectives and experiences. RESULTS: Many patients, family caregivers, and HCPs view family caregiver presence as integral to PFCC, describing the essential roles played by family caregivers prior to the pandemic. There were commonalities across all three groups with respect to their perspectives on the impacts of restrictive visiting policies on patients, family caregivers and HCPs. They fell into four broad integrated categories: (1) emotional and mental health; (2) communication and advocacy; (3) safety and quality of care; and (4) PFCC, trust in the healthcare system, and future decisions regarding accessing needed healthcare. Recommendations for pandemic visiting policies were also identified. CONCLUSIONS: The findings from this study highlighted several impacts of restrictive family caregiver presence or visiting policies implemented during COVID-19 on patients, family caregivers and HCPs in acute healthcare settings across Canada. Participants emphasized that there is no "one-size-fits-all" caregiver presence policy that will address all patient needs. To be consistent with the practice of PFCC, patients and family caregivers are welcomed as part of the healthcare team in ways that work for them, demonstrating that flexibility in family presence and visiting policies is essential.

A qualitative study exploring how patient engagement activities were sustained or adapted in Canadian healthcare organizations during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic caused disruptions across healthcare systems globally exposing the precarious state of patient engagement across all levels of healthcare. While evidence is emerging to describe how engagement was affected across various settings, insights about how some organizations at the policy and practice level of healthcare were able to sustain or adapt patient engagement activities is lacking. OBJECTIVE: This paper addresses the following research question: "How were healthcare, government, and patient partner organizations able to sustain or adapt patient engagement activities during the COVID-19 pandemic?" METHODS: A qualitative descriptive study was conducted to understand how patient engagement activities were maintained or adapted in a variety of healthcare, government, and patient partner organizations in Canada throughout the pandemic. This analysis was part of a larger qualitative, multiple case study where one-to-one interviews were conducted with organizational leaders, managers and patient partners. RESULTS: The following themes were identified as key aspects of maintaining or adapting patient engagement activities: 1) having an embedded organizational culture of patient engagement; 2) adapting patient engagement activities to focus on COVID-19 response efforts; 3) having patient partners who exercised leadership and advocacy to support patient care and experiences during the pandemic; and 4) leveraging virtual technology as a communication tool to engage patient partners. CONCLUSION: This paper highlights important insights that may be useful to other health care organizations on how to sustain or adapt patient engagement activities during a healthcare crisis. Having patient engagement embedded within an organization's culture supported by, but not limited to, infrastructure, resources, investments in dedicated staff and patient partner leadership, and communication strategies and tools enabled continued patient engagement activities during the pandemic.

Essential together: a pan-Canadian program for the safe re-integration of essential care partners

IntroductionFear of transmission throughout the Covid-19 pandemic resulted in policy changes that prohibited caregivers from entering facilities and partnering in the care of patients and residents.1 2 ‘Essential Together’ is a pan-Canadian program that aims to support health and care institutions to safely welcome and support essential care partners in care.MethodsThe Essential Together program was developed using a multi-phased approach, initiated through active listening during multiple pan-Canadian discussions that highlighted issues of restrictive visiting policies, particularly early in the pandemic. An innovative policy lab approach was conducted with key stakeholders who develop, implement, and are impacted by policy including patients and caregivers. Co-developed policy guidance for caregiver presence includes 7 key elements. Essential Together targets different audiences to move policy into action, with wrap-around supports and resources for health and care leaders across Canada to share learnings that balance the risks of Covid-19 with patient- and family-centred practices and policies.ResultsThrough regular provincial/territorial policy scans across Canada, we note that policy language has shifted, differentiating the role of ‘visitor’ from ‘essential care partner’. The valued role of an essential care partner forms the basis of policies that enable their safe presence. Surveys of healthcare organizations across Canada demonstrated a sharp drop in open family presence policies from 73% pre-pandemic (Jan 2020), with most hospitals suspending visitation with a few notable exceptions (e.g. end of life, pediatrics) (March 2020). By October 2020 and ongoing, most facilities have slowly noted essential care partner policies, but with ongoing limitations to numbers and hours.DiscussionEssential Together is a pan-Canadian program that has co-developed policies and practices to enable the safe reintegration of essential care partners.3–5 Moving into pandemic recovery and resilience, patient and caregiver engagement is key to enable a more balanced approach that supports partnership in care at all times.ReferencesFancott C, et al. Advancing family presence policies and practices in Canadian healthcare. Healthcare Quarterly 2021;24(1):14–21. Advancing Family Presence Policies and Practices in the Canadian Healt (longwoods.com)Fancott C, MacDonald T, Neudorf K, Keresteci M. Caregivers at the heart of re-imagined long-term care delivery in Canada. Healthcare Papers 2021;20(1):66–77. Caregivers at the Heart of Re-Imagined Long-Term Care Delivery in Cana (longwoods.com)Healthcare Excellence Canada. (2020). Policy Guidance for the reintegration of caregivers as essential care partners. policy Guidance for them Reintegration of Caregivers as Essential Care Partners (healthcareexcellence.ca)Healthcare Excellence Canada. (2020). Evidence brief: Caregivers as essential care partners. evidence-brief-en.pdf (cfhi-fcass.ca)Healthcare Excellence Canada. (2021). Scan of Provincial and Territorial Government Guidance for Essential Care Partner Presence and Visitor Policies. Scan of Provincial and Territorial Government Guidance for Essential Care Partner Presence and Visitor Policies (healthcareexcellence.ca)

Patient and family engagement in infection prevention in the context of the COVID-19 pandemic: defining a consensus framework using the Q methodology - NOSO-COVID study protocol.

INTRODUCTION: Healthcare-associated infections are an important patient safety concern, especially in the context of the COVID-19 pandemic. Infection prevention and control implemented in healthcare settings are largely focused on the practices of healthcare professionals. Patient and family engagement is also recognised as an important patient safety strategy. The extent to which patients and families can be engaged, their specific roles and the strategies that support their engagement in infection prevention remain unclear. The overarching objective of the proposed study is to explore how patients and families can effectively be engaged in infection prevention by developing a consensus framework with key stakeholders. DESIGN AND METHODS: The proposed study is based on a cross-sectional exploratory study at one of the largest university hospitals in North America (Montreal, Canada). The targeted population is all healthcare professionals, managers and other non-clinical staff members who work on clinical units, and the in-patients and their families. The study is based on Q methodology that takes advantage of both quantitative and qualitative methods to identify the consensus among the various stakeholders. This exploratory Q research approach will provide a structured way to elicit the stakeholders' perspectives on patient and family engagement in infection prevention. ETHICS AND DISSEMINATION: The research ethics board approved this study. The research team plans to disseminate the findings through different channels of communication targeting healthcare professionals, managers in healthcare settings, and patients and family caregivers. The findings will also be disseminated through peer-reviewed journals in healthcare management and in quality and safety improvement.

Caregivers at the Heart of Reimagined Long-Term Care Delivery in Canada: Beyond the Pandemic.

The dominant narrative through the pandemic focused on the perils associated with the transmission of COVID-19. This led to restrictive policies in long-term care that prevented family caregivers from being physically present to participate in their loved ones' care. There is growing evidence that such policies resulted in harm to residents, family members and staff. The path forward highlights the need for balanced policies and practices to ensure that compassionate, person-centred and partnered care is not lost, whether in times of calm or crisis.

Advancing Family Presence Policies and Practices in the Canadian Health and Care Context: COVID-19 and Beyond.

With the onset of the COVID-19 pandemic, restrictive visitor policies have curtailed the ability of family caregivers to be present to partner in the care of loved ones. Building on the success of the "Better Together" campaign, Healthcare Excellence Canada - the newly amalgamated organization of the Canadian Foundation for Healthcare Improvement and the Canadian Patient Safety Institute - has co-developed policy guidance and "Essential Together" programming that recognizes the significant role of essential care partners. This work aims to support the safe reintegration of essential care partners into health and care organizations across Canada during the pandemic and beyond.