What Clinicians Want You to Know About the COVID-19 Vaccine

By: Patricia Hudak, RN and Chelsea Cassidy, LCSW

The COVID-19 vaccine has landed in the United States and has been granted approval for emergency use. Many want to know what to expect in the next coming days, weeks and months. But our biggest question is… How safe is it?

What does emergency use mean?

Hearing this can often create a sense of fear or doubt that the vaccine was created too quickly and could cause more harm than protection. Our Pfizer source reports that the reason this vaccine could be developed at a high speed was due to government funding and stimulation that other projects would be outsourced to competitors. If any companies involved in the agreement were to take the lead on the development of the vaccine, then those projects that were outsourced would return to Pfizer. This puts the human condition before corporate success.

Emergency use does not mandate that we all receive the vaccine. This allows it to remain a choice.  However, what is in the best interest of our fellow man? As Dr. G. Mehfoud pointed out so clearly, “What other choice do we have to stop the spread of the virus? This is the best option to stop COVID-19.“  When the opportunity is available for him, he will proudly and courageously roll up his sleeve and receive his inoculation.

The trail participants included 40,000 people and 60 days’ worth of data. This may make you feel uneasy or leery with limited data, however; this is also an exciting time to part of history.

What to expect when your opportunity arises:

The Virginia Department of Health reports that clinicians will be notified by your agency when you can register to receive the vaccine through VAMS (Vaccine Administration Management System).

Your agency will have already provided your credentials, so you only need to bring your photo ID.

After administration, you will receive a flyer to register for VSAFE. This is an application or online website that will monitor your side effects. After the first dose, minimal if any side effects have been reported up to this time.

You will record your side effects daily for seven days on VSAFE, weekly thereafter for six weeks. It will reset itself after you receive the second dose, which is between 21-28 days after the first dose.

Recipients will continue to be monitored by VSAFE at 3, 6 and 12 months.

Higher risk of side effects has been reports after the second dose. Those with side effects have experienced fever, malaise and arthralgia. It is recommended stagger administration for staffing, if possible and perhaps taking off the following day after receiving second dose.

The three main points the CDC is monitoring after an individual has received the vaccine are if you had to miss work, unable to complete normal activities (ADLs) and if you required medical attention post vaccine.

The vaccine is free of charge. The timeline for how long it is effective is unknown – Months? Years? Indefinitely? Many of these answers remain unknown and time will be the revealer.

Many people wonder if after inoculated, do they need to continue to wear a mask? The answer is yes.  You are still able to spread the virus after being inoculated and will have to follow quarantine guidelines if you are exposed.

Because we are in an emergency phase, it warrants noting that things will be ever-changing. Please continue to give grace to yourself and those you encounter as we are experiencing this vaccine together for the first time. Let’s focus on what we can do towards healing and creating a healthier future.

Personal benefits to receiving the vaccine:

While there may be some concern surrounding receiving the newly released COVID-19 vaccine, routine process and procedures remain in place to ensure the safety of anyone who receives it. Receiving the COVID-19 vaccine can help combat certain aspects of your life that COVID-19 has affected/will affect.

  • Receiving the COVID-19 vaccine can help prevent an illness that could lead to future health complications or loss of workdays due to an illness.
  • Protecting your loved ones is important now, more than ever. Receiving the vaccine can help relieve some of stress of contracting the virus from/giving the virus to your loved ones.
  • The COVID-19 vaccination will be an important tool to help stop the pandemic. As more and more people receive the vaccine, we will be one step closer to normalcy.

Home Health Care Can Help Seniors With Loneliness and Social Isolation

By: Elizabeth Townsend, RN

People are social beings. With COVID-19 introducing social distancing guidelines and restrictions on visitations, social isolation and loneliness are increasing. A report referenced by JAMA discussed the need for solutions for social isolation and loneliness in older adults. There is significant documentation that social isolation and loneliness are related to a higher rate of major mental and physical illnesses, including:

  • Cardiovascular and cerebrovascular risks
  • More depression and anxiety
  • An increased risk of dementia

According to the National Institute on Aging, people who participate in worthwhile activities with others tend to live longer and have a sense of purpose.

Assessing seniors for isolation and loneliness

COVID-19 has made it difficult for seniors to participate in:

  • Social gatherings
  • Communal dining
  • Exercising in groups
  • Social programs at senior centers
  • Volunteering

Home health clinicians assess patients for social isolation and loneliness. Asking patients about their social needs is important to identify who needs assistance, easing isolation and loneliness. The home health agency provides tools or guidelines with questions for the clinicians to ask. Examples of questions to ask:

  1. Do you feel you have no friends or loved ones?
  2. Are you lonely?
  3. How are you staying active?

5 ways to relieve isolation and loneliness

After assessing and finding that your patient is suffering from social isolation, consult with their caregivers and healthcare team —specifically the agency’s social worker—to find ways to relieve their isolation. Daily Caregiving suggests some ways to help:

  1. Encourage a sense of purpose. Suggest activities such as knitting blankets and caps for newborns at a local hospital, making masks for healthcare workers or family members, or writing letters to their grandchildren to encourage them. Allow the patient to have a responsibility, such as taking care of a plant or dog. This would be giving them a meaningful purpose.
  2. Encourage interaction. Encourage interaction with others via phone, computer, or if in person, socially distant, wearing a mask.
  3. Encourage physical activity. Take Into account the patient’s physical ability. They can do gentle exercises such as walking, stair-climbing, yoga, or group exercises via computer. If they cannot get out of bed or are not able to walk, find appropriate activities. Consult with the physical therapy team who can provide resources for exercises for those with limitations.
  4. Assess the food they are eating. Encourage fiber-rich foods like fruit, vegetables, whole grains, and lean proteins. Consult with community services such as food banks, churches, or meal delivery services.
  5. Show them they are loved. Find ways to show that they are loved and needed. Listen to what they have to say. Encourage family members, if they are in the home also, to hug the patient and talk and listen to them.

Social workers can help seniors with social isolation and loneliness

Social workers can ensure that patients have access to available resources. Local churches may have “shut-in” outreach for those unable to leave their homes. They may provide phone calls, run errands, provide food baskets, and communicate by mail with the seniors. Local library programs have online programs and can arrange to have books available for the patient to check out. The social worker can also refer the patient to transportation programs that take seniors to doctor appointments.

Encourage virtual connections for seniors

Advancing States created a resource to help reduce social isolation and loneliness.

  1. If the patient can use a smartphone, show them how to google Earth National Park Tours so they can “visit” the parks and talk about what they saw with others via telephone or with you when you visit.
  2. Patients can meditate through Journey Meditation.
  3. Put the patient in contact with Well Connected by Covia, who will help them participate in virtual classes, conversations, and activities by phone and computer.

There are helplines for mental and emotional support, which include:

  1. Friendship Line by Institute on Aging- 1(800)971-0016
  2. Happy– a free app that provides emotional support 24/7
  3. National Alliance on Mental Illness Helpline- 1(800)950-6264
  4. Substance Abuse and Mental Health Services Administration National Helpline- 1(800)662-4357

Grief During the Holidays

Grief. It’s a small word with a big effect. At worst it is crippling. At best it is nagging. And holidays seem to magnify the heartache that follows grief, regardless of when the loss took place.

For some, pushing through the holidays and honoring time old traditions can be the perfect way to memorialize a loved one. But for others, creating and celebrating new traditions or skipping the holiday festivities altogether might be easier to bare.

There’s no right or wrong way to grieve during the holidays. Even two people who experienced the same loss will grieve differently. Many factors, such as the relationship to the deceased; the surviving individual’s belief and spirituality; past experiences with loss; and the survivor’s willingness and ability to express their grief can impact each survivor differently.

Regardless of how you choose to celebrate or not celebrate the holidays, the following steps can help you feel more prepared to handle your grief:

  1. Acknowledge that the holidays will be different.
  2. Acknowledge that the holidays will be tough.
  3. Communicate your holiday plans with family and friends so that they will know what to expect.
  4. Recognize that even family and friends within your own grief circle may have different plans for how they wish to spend the holidays. Seek to find common ground, establish your plan should the holidays become too much for either party, or choose to celebrate separately if their plans conflict with your level of comfort.
  5. Seek help from a friend that you trust who can be there for you without offering advice or trying to “fix” your grief.
  6. Say “yes” to help if you need the support.

Our wish for you this holiday season, and always, is that you can find joy amid sorrow as you remember your loved one.

COPD Patients: Doctors Call For Earlier Hospice Referrals

By: Wilma Peterson, RN

According to the American Lung Association, Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in the United States. Due to the distress and panic caused by difficulty in breathing, living with COPD can be stressful for both the patient and the family. Doctors are beginning to call for earlier hospice referrals for these patients. If accessed at the right time, hospice care can better manage symptoms, prevent unnecessary hospitalizations, and better quality of life.

Patients with advanced COPD are eligible for hospice care, which is fully covered by Medicare, some private insurances, as well as assistance from Veterans Affairs. Hospice patients have access to the appropriate care and medications, allowing for more restful periods and easier breathing. Identifying these factors early can relieve symptoms such as anxiety, panic, labored breathing, and intractable coughing that are uncontrolled with regular medications and traditional therapies.

Factors to consider when deciding whether a COPD patient is appropriate for a hospice referral include:

  1. The patient has a projected life expectancy of 6 months or less
  2. All therapies, including medications and rehabilitation, have been exhausted
  3. The patient has frequent emergency room visits and hospitalizations due to exacerbation of COPD

At this point, the patient is considered to be in the advanced stages of COPD, and the discussion for hospice and end-of-life care should begin.

Eight benefits of early hospice referral for those with COPD

Receiving hospice care early allows for the expertise of a focused team of professionals:

  • Physician
  • Nurses
  • Social worker
  • Chaplain
  • Ancillary services

Hospice services are available 24/7. The team will provide medical, emotional, psychological, and spiritual support to the patient and family. Here are eight benefits of early hospice referral:

  1. Early intervention. The earlier the referral is made, the more it allows the patient and the family to choose the right hospice company and be a part of the care plan.
  2. Managed care. A physician leads the hospice care team. The physician can order the appropriate medications and therapies and cater to a plan to meet the patient’s specific needs.
  3. Skilled Nurses. A registered nurse will meet with the patient and family and can admit the same day. The nurse will also reconcile all medications, put together a plan that focuses on managing symptoms, and provide relief of pain and respiratory distress.
  4. Hospice Aides. Health aides assist with normal daily activities:
  • Washing
  • Grooming
  • Dressing
  • Ambulating safely
  • Other household chores
  1. Medical Social Worker. A social worker will assist with accessing support in the community, such as respite care and other services. The end-stage of COPD causes a severe reduction in personal and social quality of life with increased stress levels for all involved.
  2. Chaplain. Clergy to meet the patient and their family’s psychological and spiritual needs, assisting them through the grieving process.
  3. Ancillary services. Other ancillary services like physical therapy and occupational therapy, strengthen muscles to assist with safety and allow for a sense of independence.
  4. Respite Care. Allows time for self-care and rest, which can help with a change in attitude and mindset in caring for your loved one.

Living easier with hospice care

Early hospice referrals allow for the early management of symptoms by:

  • Having the appropriate therapy and staff when needed
  • Avoiding the stress of emergency exacerbations and hospital visits
  • Providing a more focused approach to the patient and caregiver
  • Alleviating stress and encouraging future planning like spending quality time and making plans

Early referral can provide more support for both the caregiver and the patient as they go through the grieving process.