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SWHPN Guidance for Talking About Masks

As some social workers who have been working remotely are now returning to work and going into people’s homes wearing masks, we are hearing reports that some are getting pushback from both patients and coworkers about wearing masks. Some have shared that patients have expressed a worry that this is an indication that they may be sick with COVID-19, while coworkers have expressed that they do not feel they need to wear masks for various reasons. Below we offer some suggestions for responses that you could give to both of these groups. These responses were provided to us from various social workers we have spoken with, while others come from a variety of resources you can click on to learn more.

Some suggested prompts:
I wear a mask in every patient’s home and in all public spaces while I am working.
One of the first responses you might choose to give to patients can be to normalize that this is standard procedure, something that has been recommended by the Centers for Disease Control for all people to wear a cloth covering their nose and mouth in public spaces or in situations when they cannot be physically distanced (6 feet apart). The primary reason for healthcare workers to mask is to protect patients. In this way, we keep any germs that we may have from transmitting from ourselves to them and we are following recommended practices that are based on scientific evidence. While we do not suspect that we have the virus at this time (if we did, we would be at home and not at work), research has shown that people can be infected with COVID-19 and not showing any symptoms for up to 2 weeks before they begin to feel ill.

Wearing a mask is not a political or cultural statement for me.
While I understand some people believe that by wearing a mask, they are stating that they have a certain belief, my personal beliefs have nothing to do with the choices I make at work. Rather, I make choices based on the policies of my employer and what is recommended as in the best interest of the patients and families that I work with.

Frequently Asked Questions:
What if a patient or family refuses to allow you in the home if you are wearing a mask but your agency has asked you to wear one or you feel it is what is recommended for patient care?
SWHPN recommends that you do not visit patients and families in person without wearing a mask until general masking recommendations have been lifted by the CDC, and especially if masking is recommended by your employer. If a patient or family member feels that a mask is an obstacle to a visit, we recommend that you do not remove the mask for a visit, but change this particular patient’s care plan to be one that is virtual when possible, unless the family member that objects to masking is not present or changes their objection.

What if a co-worker refuses to wear a mask?
We have heard reports from some hospice social workers that some coworkers do not want to wear masks for various reasons (I live alone, I know I am not sick, etc.). Because we as social workers know that we cannot control another person’s behavior, and masks are intended to keep other people healthy, rather than the wearer, we know that this can potentially impact your health. If a co-worker refuses to wear a mask, you have 3 options: talk to them and provide education, speak to your leader about the issue, or stay at least 6 feet away from this co-worker, something you can control.

Another talking point you can try is sending them articles about masks, like the one above from the CDC, or one of these from NPR: https://www.npr.org/sections/health-shots/2020/06/21/880832213/yes-wearing-masks-helps-heres-whyhttps://www.npr.org/2020/06/17/879682816/a-growing-body-of-research-highlights-the-importance-of-wearing-face-masks, and https://www.npr.org/2020/06/11/875311079/how-the-widespread-mask-use-could-slow-the-coronavirus-pandemic.

Of course, there are many different people in the world and they may have their own reasons for not wanting to wear masks. As one author writes about here in The New York Times, many black men are afraid to wear masks for fear of racial profiling. In the Atlantic, another author posits that a public health approach for people who feel asking them to mask is infringing on their rights, taking an empathetic approach, as outlined here, will be more successful than badgering, shaming, or pushing. 

One final thing to consider when providing patient education: utilize tools that are culturally competent and meet the health literacy needs of the patient and family. There are a number of healthcare inequities which are being highlighted during this pandemic and as a social worker, it's important to address and discuss these issues with your clients so that you can assess and hopefully address what barriers may exist within their medical services. Providing linguistically and culturally appropriate education is a start. Talking openly about racial and ethnic inequalities with your patients and families is a step. We will be posting more about racial and ethnic disparity and the COVID-19 pandemic on this site, but here are some tools you can use when educating about masks and COVID health literacy:

SWHPN Shares: Being a Hospice Social Worker in a Time of Crisis

A few months ago, a Child Life Specialist who I work closely with and I discussed talking about feelings. She assumed I'm good at this because I talk about feelings all day long—most days at work, and often with colleagues and friends who come to me to talk through difficult emotions. I laughed and said, "Yes, I spend all day talking to people about their emotions; that's easy. Talking about my emotions is something else altogether." If I were to gather a room full of social workers together, I'd be willing to bet the same would be true for many of us.

But now that a worldwide crisis has hit, we're forced to face at least some of our emotions on a daily basis in order to manage our own mental health and coping. For me, as someone with a mental illness (major depressive disorder), I have to be conscious not only of my treatment (medication and therapy adherence on a routine schedule) but also how I am tapping into my own coping mechanisms. As we ask in our field, how are they working for me? In addition to the struggles with depression I typically deal with, which can be amplified by isolation and hopelessness if I let them, I also struggle with a feeling that many people are confronting now, especially those with disorders: anxiety.

One tool we can use to help us manage anxiety is mindfulness, as it can help us to focus on the present moment and stop perseverating on the past and the future. There are a number of free tools out there right now that can be helpful with this: Mindful.org has a page of free resources, including articles and meditations. MindwellU has a 30-day mindfulness challenge that can encourage you to slow down a few times a day.

Another tool that can be helpful is to put the experience we are all having in a cognitive frame that makes sense for you. In the first episode of her podcast, Unlocking Us, Brene Brown speaks about something she labels "FFTs" for "_______ First Times", and she shares that the ability to normalize experiences that are foreign to us, like going through a pandemic, helps us realize that our responses, like anxiety and fear, are typical. This helps us put the experience into perspective and reality-check our expectations. In this way, Brown gives us a tool with which to respond to the FFTs we keep experiencing during this crisis, so that we can stop reacting to the experience and start living again.

Since we talk about going back to the social work basics in times of crisis, it doesn't hurt to mention the self-care basics when dealing with feelings of anxiety, stress, and worry:





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Goodbyes in the Time of COVID

As COVID-19 has changed visiting policies in hospitals and other facilities, it has also changed how people say goodbye to the ones they love, and how we as social workers support them in saying those goodbyes. Anticipatory grief is happening virtually and in isolation, and part of our work during this pandemic is connecting families with patients, supporting them as they say goodbye, and acknowledging the loss of saying that goodbye in person. As a palliative care social worker, I have encountered many instances in which family members could not be present to say goodbye to the patient. Some family members are COVID+ themselves, are immunocompromised, or live across the country or world. While one healthy visitor is allowed to visit a patient who is imminently dying, predicting someone’s final hours and minutes can be difficult to do, and sometimes family are concerned about coming to the hospital and putting themselves at risk.

Technology has allowed us to support families in their grief, and for those who do not have access to a video camera, telephone communication has proved vital. There are some roadblocks to connecting families with patients- clinicians working remotely, a limited number of staff who are allowed to enter a COVID+ patient’s room, a high number of palliative care consults, limited technology that staff and family members have access to, and ever present technological glitches. Despite these barriers, my palliative care colleagues have wielded creativity, compassion, and collaboration to facilitate goodbyes, and share messages of love in a time of overwhelming death and despair.

Over the past several weeks, my team has been able to coordinate Zoom video meetings so that families can see their COVID+ family members at the end of their lives. We have set up Zoom meetings, disseminated the login information, and our physicians and nurses have brought iPads to patients so families could see their hospitalized family members. In instances where the physician cannot enter a patient’s room (either to limit exposure or to conserve PPE), and the patient cannot hear their families on the iPad, we have invited those in attendance at these meetings to write messages in the chat box, or to say messages out loud with the promise that we would deliver these messages to the patient. Over Zoom, families have joined together in grieving the loss of their family members who have meant so much to them, sharing memories and gratitude, and saying their goodbyes.

After these meetings, I have transcribed their written and spoken messages so they could be placed by the patient’s bedside. The physician on my team suggested I compile them into transitional documents for families, which they could continue to reflect on as the patient transitioned. I have emailed the documents to families with space for additional messages for those who had been unable (either logistically or emotionally) to join the call, and placed one-page abbreviated versions by patients’ bedsides so physicians and nurses entering the rooms could read brief messages to patient from their families. This interdisciplinary intervention aimed to facilitate connections between patients and families, and we hoped it would provide opportunities for care providers to connect with their patients as well. Working within the boundaries we had, we hoped to provide support, and were grateful that families could connect with patients and with one another through video and written text.

Another intervention we have used with caregivers for patients who did not have access to a video camera or smart device, and were unable to visit at the end of life due to visitation restrictions, was to pass on messages verbally. In circumstances where bringing a phone to the patient is not possible, I have asked friends and family members what they wanted to say to patients. They have shared messages such as “You are not alone” and “I love you.” These messages are then imparted to the patients by physicians, nurses, and social workers. It is so important for friends and families to know that, though they are not with them physically, their messages will be delivered.

Collaboration has always been inherent in palliative care, though I have never been as grateful for it as I am now. As families and patients remain in quarantine, healthcare workers are bringing people together virtually in a number of creative ways, and palliative care social workers are uniquely positioned to provide anticipatory grief support to the families and friends of patients with COVID-19. As we navigate the psychosocial impact of COVID-19 on grieving families, we can continue to explore new ways of facilitating communication and share our newfound interventions with each other.


Kasey Sinha, Palliative Care Social Work Fellow at Mount Sinai Beth Israel in New York, NY. SWHPN is accepting guest submissions on COVID-19 practice and interventions at [email protected].

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When You're Working Remotely as a Hospice or Palliative Care Social Worker

 

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Special Call for Papers: Social Work Practice during Coronavirus (COVID-19) Pandemic

Deadline: December 31, 2020

The coronavirus pandemic has created changes and challenges in how social work practice is being conducted in all areas of the health care system due to guidelines and restrictions put in place in response to the pandemic. Thus, hospice, palliative and other social workers are being tasked with supporting individuals, families, and co-workers in new, unforeseen, and creative ways. In this special issue, social workers are encouraged to share reflections about the situations, challenges and changes they are experiencing as well as the processes of new ways to connect with those in most in need of intervention. In addition, it is important that social workers’ practice self-care and so papers on approaches to doing so during this stressful time are welcome.

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Working with Families Facing Undesired Outcomes During the COVID-19 Crisis

As SWHPN gathers resources for its social workers who are facing an unprecedented time in their practice, we've issued our first tip sheet: Working with Families Facing Undesired Outcomes During the COVID-19 Crisis.

You can find tip sheets and additional tools, resources, and information on the COVID-19 Resources PagePlease share widely.

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