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https://www.infirmiere-canadienne.com/blogs/ic-contenu/2021/03/01/detresse-morale-dune-infirmiere-en-gerontologie-au

Mar 01, 2021, By: Laura Eggertson

As COVID-19 continues to batter Canada’s increasingly fragile long-term care system, the personal and professional worlds of nurse researcher Lori Schindel Martin, who specializes in caring for older people, have collided.

Schindel Martin, a professor at Ryerson University’s Daphne Cockwell School of Nursing, has spent much of the pandemic teaching and working with a team to survey more than 150 Ontario nurses about their work caring for older adults with COVID-19, with dementia and with other medical conditions affecting their health and independence.

As the responses come in, she’s also analyzing the nurses’ reports about how they are coping with the stress.

Schindel Martin is reading accounts of nurses deprived of time to explain to frantic family members the implications of their loved ones’ conditions. These nurses also struggle to communicate with older adults with visual or hearing impairments, who can’t lip-read or see facial expressions clearly through visors and masks.

Nurses can no longer get critical information about family histories or make cultural connections to long-term care residents because the family members they relied upon to translate or ease anxiety for loved ones are no longer allowed to visit in person.

As she reads the nurses’ accounts, Schindel Martin is experiencing the same distress as a family member. Her 86-year-old mother-in-law is sinking deeper into dementia in a long-term care home in Niagara, where COVID-19 restrictions keep Schindel Martin and her husband, David Martin, from in-person visits.

Moral distress

“There’s a lot of moral distress that is happening with respect to the educated and well-trained health-care providers who are working at the bedside with older adults,” she says from her home in Hamilton, Ont.

“Nurses are being quite resilient, but nurses have been affected very strongly by bearing witness to patients’ suffering through this process.”

Nurses report their distress at being unable to comfort residents with a hug or a touch. They must watch people with dementia being moved back and forth to unfamiliar settings for COVID swabs.

They’re trying to reassure terrified older adults looking at unfamiliar people “goblined up” in blue personal protective equipment.

“I am extremely proud of the many nurses I know across the country who have been working in the long-term care sector during pandemic conditions; they have engaged in tremendous effort to keep older people and their families safe and connected despite the need for social isolation,” Schindel Martin says.

But the conditions are taking their toll on nurses and others working in long-term care, says Schindel Martin, who is also the president of the Canadian Gerontological Nursing Association.

To alleviate their stress, nurses are using mental health resources available online, including cognitive-behavioural therapy. During shifts, they’re trying to take breaks to eat, drink water, breathe deeply and stretch.

Personal stress

“These are really survival skills,” Schindel Martin says.

She feels their stress and pain at a deeply personal level. Her mother-in-law, Connie, who Schindel Martin has known since she was 17, struggles with being able to use the telephone or an iPad to communicate with the family. The recreation staff at the facility where Connie lives try to help by showing her video clips of her great-grandchild’s first steps.

The now-documented neglect of older adults in long-term care across Canada during the pandemic has left Schindel Martin not only sad but angry.

But they can’t replace the visits from Schindel Martin and her husband. No matter how good the staff are, they can’t connect with Connie by sharing csirke leves, the Hungarian chicken soup with csiga, handmade, screw-shaped noodles, that she once made. They don’t tell her stories about the perfect kifl cookies, made of tender, flaky pastry stuffed with plum jam or ground walnuts and sprinkled with sugar, she used to bake.

The isolation is taking its toll on Connie, who has stopped calling them by their names when they do speak, Schindel Martin says.

That disconnection is also affecting Schindel Martin — as is her awareness of the suffering of the older adults and the nurses around her. She’s coping by deep breathing, reading and sometimes singing in a virtual choir established by one of her Ryerson colleagues.

The now-documented neglect of older adults in long-term care across Canada during the pandemic, such as residents abandoned at the Résidence Herron in Dorval, Que., has left Schindel Martin not only sad but angry.

She’s frustrated that the response of some provinces, including Ontario, is to propose hiring resident care aides rather than enough skilled, trained nurses who can constantly observe, assess and respond to older adults’ multiple medical conditions and needs.

Skilled nurses

“Some long-term care homes are hiring people off the street and training them without any standardized education,” Schindel Martin says.

“The acuity, on top of the chronicity, of older people in every nursing home in Canada is such that they require educated staff who can practise to the standard of the Canadian Nurses Association and the gerontological nursing certification exam that they have,” she says.

Many of the nurses who belong to the Canadian Gerontological Nursing Association are educated in gentle, persuasive approaches, a method of caring for people with dementia that Schindel Martin teaches. These nurses have been trained to recognize the difference between delirium, depression and dementia.

Schindel Martin believes that with the right personal protective equipment and training, family caretakers could work safely during the pandemic.

They can spot interactions among medications. They can often avoid the need for emergency visits by administering oxygen, using wedge pillows and providing inhalers and comfort care.

All of this training, and much more, is part of a gerontological nurse’s education, something Schindel Martin says policy-makers — and the public — don’t realize.

Ageist society

The pandemic has revealed that Canada is a pervasively ageist society, Schindel Martin says.

“It is so ageist that we think caring for older people is a simple undertaking,” Schindel Martin says. “People living in long-term care homes have complex disease and medical conditions that require equally complex assessment. I am exasperated. The government cannot be listening.”

Instead of hiring untrained aides, Schindel Martin is advocating that family members who already know how to care for their loved ones be trained — and paid — to work in long-term care homes, assisting nurses and personal support workers.

She cites the example of Kensington Gardens, a 350-bed long-term care home in Toronto. The CEO acted on staff suggestions by hiring and training six family members as unit aides to respond to staff shortages during the pandemic. The aides must care for everyone on their floor — not just their own family member — and help with socialization, recreation and online visits.

“Why wouldn’t you leverage the families? Instead, some homes are saying ‘No’ to family — you can’t come in — even though family have a whole host of what we would describe as professional craft knowledge.”

Schindel Martin believes that with the right personal protective equipment and training, family caretakers could work safely during the pandemic.

Meanwhile, she will continue to advocate for the skilled gerontological nurses providing care in all settings, for family members and for isolated and aging adults.

“We need to push against some of these rules.”

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In spring 2020, the Canadian Nurses Association (CNA) established a national long-term care panel composed of nurse experts. This panel is informing CNA’s policy responses as it pushes for the reforms needed in the broad sector of aging (and not just institutional long-term care). Lori Schindel Martin is a member of that panel. Check out CNA’s recent work in collaboration with the Canadian Medical Association and other organizations: National Standards for Long-Term Care: The Art of the Possible. Throughout 2020, CNA advocated for a comprehensive examination of the programs and services needed to support healthy aging in Canada. Work on this important issue is ongoing; CNA recently met Green Party leader Annamie Paul and Senator Judith Seidman.

Laura Eggertson is a freelance journalist based in Wolfville, N.S.