Penn Pandemic Diary Penn Pandemic Diary, Entry #32: In It For The Long Haul

Stacey Bevan is a PhD candidate in Nursing at the University of Pennsylvania and a Perry World House Graduate Associate.

It’s midnight on a Sunday. I’m driving home from the region’s largest psychiatric hospital where I work part-time as a nurse. Recently, I spent a shift calming a young woman with a history of abandonment. Secluded due to a high fever, she was pacing in her own room, crying and occasionally throwing her pillow against the wall.

Under normal circumstances, her treatment would include therapies to help develop healthy relationships and process past traumas. Unfortunately, most of this programming is temporarily suspended. At a time when belonging is a key need for this patient, we needed to prioritize her physical safety over the most therapeutic treatment plan.

My patients are adolescents, often admitted for destructive behaviors or severe changes in mood. Our interdisciplinary team helps to medically stabilize them while providing care management and social services. During the pandemic, we do the best with what we can provide. In this case, our team decided on a series of coping strategies that would allow her to sleep until testing in the morning: breathing techniques, progressive muscle relaxation and a hot shower. I found a book for her and pulled an order for melatonin. For this patient and many others, COVID-19 protocols add an additional layer to an already distressing hospitalization.

As in every medical setting today, COVID-19 has changed a great deal. For our teams, communicating through face masks, constantly cleaning surfaces and avoiding groups has complicated our care. For patients, the pandemic protocols add to the already overwhelming experience of being subject to checks every 15 minutes. The additional anxiety of practitioners and patients alike is palpable.

I’m grateful for the opportunity to do my part as a provider in the pandemic. Nurses are patient advocates in and out of clinical settings. The pandemic has expanded the needs of our patients and the need for our skills and care; but we cannot help the patients we don’t see.

To put this into context, our nation’s kids are contending with distance learning, some in homes that are far less safe for them than schools. For children with developmental and behavioral differences like Autism, this shift means they are missing critical services delivered at school. The financial stresses of Philadelphia families, with unemployment rates higher than the national average, also have profound effects on children’s basic physical and psychological needs. During the pandemic we are evaluating far fewer children than likely need care since most of our psychiatric referrals are from social services that are currently suspended.  

On my way home, I drive past Children’s Hospital of Philadelphia and the Hospital of the University of Pennsylvania, where my medical colleagues are fighting COVID-19 up close, managing intubation tubes and IV lines. They are struggling to keep their team safe with scarce supplies. I’m somewhat comforted that I’m helping divert patients in psychiatric crisis out of their emergency department and into more appropriate care. However, I know nurses in medical hospitals are caring for bodies as well as minds, now more than ever.

As I pull down my street in West Philly, I remind myself to check in with a handful of friends providing front-line care in the morning. We’re trying to minimize the ‘second-wave’ of the pandemic: increasing mental health needs exacerbated by social isolation, financial hardship and trauma. Investing in ways to combat these symptoms of COVID-19 extends beyond maintaining supplies of gloves and masks.

I park my car and begin to think about Monday, where I resume my work as a PhD student. This week, I was supposed to be in Latin America, recruiting for a pediatric study funded by a health equity grant. This project was of course postponed, as research activities at Penn are limited to what can be done remotely. These days, data analysis, critical reading and writing inevitably take longer and with more effort. During the pandemic, nurse scientists continue to balance teaching, clinical care and research. Keeping all the balls in the air isn’t always easy, but nurse scientists are resilient. We find stamina from our students, patients and colleagues. After all, we’re in this for the long haul.

The views expressed in the Penn Pandemic Diary are solely the author’s and not those of Penn or Perry World House.