One of the “most wrong” moments of Dr. Jennifer Foster’s career as a pediatric intensive care unit (PICU) physician happened in the midst of the COVID-19 pandemic.
She works at the IWK Health Centre in Halifax, where visitor restrictions have recently been implemented as a safeguard against the record-breaking spread of the virus in Nova Scotia.
“Both parents had been brought into the health-care centre to discuss their child, but not in the intensive care unit, and one of the parents asked if they were in the building anyway, could they go see their child,” she recalled.
“I had to say no to that, and it felt like the most wrong thing that I’ve had to do in a lot of my career.”
Such instances, said Dr. Foster, and her previous research on improving family experiences in hospitals, helped drive a new national research program on how pandemic visitor restrictions have impacted PICU patients and their families. The results will help inform evidence-based family presence policies that can be adapted in the event of future threats.
“There hasn’t been anything before this pandemic to say, ‘What should we do in a pandemic?'” said Dr. Foster from her home in Halifax. “One thing that we’re consistently hearing from people is, from the beginning, there needs to be a mechanism in place so there can be exceptions to the rules in really significant situations.”
Since the start of the pandemic, there have been many reports of families either unable to visit their loved ones in hospitals due to restrictions, or unable to have as many visitors as would normally be permitted.
Data is already pouring in from across the country, said Dr. Foster, and it’s clear there’s a desire for such policies to consider local epidemiology, and be flexible in case of emergency. She said she’s also heard many reports of sick children asking for loved ones who aren’t permitted to visit, such as siblings or grandparents.
“The intensive care unit is not only a high-intensity place, but it’s a place where there’s a lot of emotion, where kids are incredibly sick and they are at high-risk of deterioration or dying,” she explained.
“Experiencing that alone as a parent or a child, and not having the normal family support that you need or would want can be incredibly impactful and has a risk for a significant amount of trauma.”
Dr. Foster is leading the research program with Dr. Jamie Seabrook of Brescia University College in London, Ont., PICU nurse practitioner Laurie Lee of the University of Calgary, Edmonton intensivist Dr. Daniel Garros, and Calgary-based research Dr. Kirsten Fierst. Twelve PICUs across the country have agreed to hand out surveys to their families, which will complement interviews with parents, children, health-care workers and administrators.
Parent partners, who tend to sick children themselves, will inform the key themes and survey questions in the research program. They’ll also review the findings and have input on how they’re presented, to ensure the experiences and needs of families and patients are reflected.
“I think it’s important because it’s going to set the parameters for what happens in the future,” said Corey Slumkoski, a parent partner with his wife Martha Walls in Halifax.
Their eight-year-old daughter, Quinn Walls-Slumkoski, has spent many weeks in intensive care due to chronic health issues. She has been fortunate not to have been hospitalized during the pandemic, said her mother, but they know how difficult it would have been if she needed intensive care and both her parents were unable to be there.
“One of the things that really was helpful for us dealing with a really terrifying situation in an unfamiliar place, was to have your spouse or another family member there to talk to … but also just as a support person to get away, to leave the bedside, go for a walk or go get a cup of coffee,” said Walls.
“Under current pandemic restrictions that’s not been possible in PICUs across the country. There hasn’t been the ability to come and go, and often one parent is identified as the person to be at the bedside. I can’t imagine how difficult that is for that one parent, but also for the parent who can’t be there to comfort their child.”
Dr. Foster said she hopes the research program, its findings and recommendations will be published and distributed in about two years. The program is funded by the Canadian Institutes of Health Research and the IWK Health Centre.