Hospital visitors donate iPad stands after some patients felt guilty FaceTiming family members

By Julia Gregory, local democracy reporter

During lockdown hospital visits by family and friends were severely restricted.

Hospitals embraced digital technology to keep people in touch – including for heartbreaking calls to dying relatives.

Whilst most people using video calls welcomed them as it meant they could keep in touch, it left some patients and nurses feeling guilty, according to a senior nurse at a leading London hospital.

Claire Gorham, the nurse matron at adult intensive care at St Mary’s Hospital in Paddington explained that  patients were “feeling guilty that they were keeping nurses from doing work while they were having to hold the iPads”.

She said patients were also concerned that they were having conversations with loved ones that they felt were quite private and had to be mindful that there was a nurse or a healthcare assistant standing behind the iPad.

“Overwhelmingly during the pandemic they felt bad that they were keeping the nursing staff away from delivering other patient care,” said Ms Gorham.

Visitors donated stands for the tablets so they could be attached to beds and patients could make the calls by themselves.

She shared the challenges of using digital technology during a moving patient experience session at Imperial NHS Trust’s digital board meeting.

Over the last year 5,000 patients with coronavirus were treated at St Mary’s, Charing Cross and Hammersmith hospitals and 4,500 have recovered.

Numbers of family visits to dying relatives had to be kept limited to prevent the spread of coronavirus.

“How awful not to  have spent that time with your loved one at the end of life it’s just so sad,” said Ms Gorham.

And “sometimes patients didn’t want to have the video calls and they didn’t want to be seen by their loved ones so unwell in critical care, or if they were going through a long-term illness often our patients do become distressed understandably or withdrawn.”

She added that some patients who later died did not want to have video calls.

“That was really distressing for our family members,” she said.

Calls made about dying patients were particularly difficult.

Pre-pandemic medical staff could talk to relatives face-to-face about the end of life decisions around their loved ones.

But Ms Gorham said: “We were having those conversations over the phone with the doctors, the medical team and then followed up sometimes by a video call with the nursing teams.

“Our nursing teams found these video calls extremely distressing. We didn’t give them strategies to start and finish calls.

“We had staff members coming in feeling really distressed at being unable to end calls.

“And also that other relatives could hear the distress of their loved ones via iPads or patients that were sitting in the bed next to these patients could hear the conversations, so these were really challenging to manage.”

She said the devices were fantastic in connecting  patients recovering from serious illness with loved ones. But for those who were not getting better  it “presented challenges” and was “clearly no substitute for having relatives in our visiting areas.”

She told Imperial NHS Trust’s board meeting of the iPads: “They have overwhelmingly been a positive thing but they haven’t come without their challenges both for patients, families and for our workforce.”

As the pandemic hit hard  nurses were very busy as “patients with the virus in critical care were so so sick so they were hugely time demanding. So to be able to free themselves up to do those calls was really challenging.”

Sometimes junior nurses were caring for up to  four critical  patients at a time because of the demands of the pandemic.

“I think there’s a huge amount of guilt from the nursing workforce when they haven’t been able to deliver the end-of-life care they would have liked to deliver and that’s really sad for me as a manager when I know these nurses have gone above and beyond,” said Ms Gorham.

The staff have been given well-being and psychological help, as well as communications training to start and finish those difficult calls as the team learnt about the challenges digital calls posed.

“The team have been awe-inspiring when you work with them, it’s been overwhelming what they have achieved and that  they go home with this guilt at not being able to deliver this end-of-life care that they set their standards so high is difficult.”