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The person behind the PPE: nurse uses smiling photo to break down barriers

May is Nurses Month, and M Health Fairview nurse Sheila Kingston is building connections with her patients during the COVID-19 pandemic in a simple but powerful way.
Registered Nurse Sheila Kingston carries a 8x11-inch smiling photo with her during her shifts at M Health Fairview University of Minnesota Medical Center. Kingston places the badge on the white board in each patient room for the duration of the shift. “A smile is universal,” she said.
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The N95 mask, gloves, plastic face shield and other personal protect equipment (PPE) that Registered Nurse Sheila Kingston dons each time she enters a patient’s room are vital for her protection against COVID-19 – but they don’t make communication very easy.

That’s why Kingston, who works at M Health Fairview University of Minnesota Medical Center, printed out a large smiling photo of herself that she displays in patients’ hospital rooms during her shifts. The picture is a simple but powerful connection builder: It gives patients under Kingston’s care a chance to see the person behind the PPE. The picture is wrapped in plastic to make disinfection in between room visits easy.

“Using the photo when I first introduce myself to patients creates an opening for them to get to know me, their bedside nurse,” Kingston said. “Patients smile when they see the photo, and comment about how nice it is to put a face to the voice and know who is talking to them. They are reassured when I return since we have already made this connection.”

Pandemic precautions have made masking necessary, but Kingston is aware of the isolating effect it can have on the people under her care. In a patient’s eyes, Kingston said, it can feel at times like everyone is masked and equally unfamiliar. Visitor restrictions – another safety measure implemented to prevent COVID-19 spread – have also limited the number of family members and friends a patient can see.

“I think it must feel very frightening and sometimes invasive when a patient has a stranger performing a procedure, treatment, examination, or administering medications, and the patient cannot even see the nurse’s face behind all the PPE,” Kingston said. “We are the primary caregivers in the room with them for the duration of their stay. It’s important to establish a trusting and positive nurse/patient relationship.”

To break down the sense of isolation, many care providers are finding innovative ways to communicate with patients during the COVID-19 pandemic, including friendly photos like the one Kingston brings with her. M Health Fairview staff members are also using donated iPads to facilitate video chats between patients, their care teams, and family members.

At University of Minnesota Medical Center, Kingston works on a COVID-19 cohort unit with patients who are either suspected of having or are diagnosed with COVID-19, as well as other complex medical conditions. After testing, they are given comprehensive care tailored to their needs.

For Kingston’s patients, this may include mental health challenges and other special needs, such as altered mental status, dementia, schizophrenia, developmental delays, autism, cerebral palsy, and others. Some do not have the ability to understand the full scope of their situation or the capacity to express or communicate how they feel during when isolated in a hospital setting.

Others have hearing loss and normally rely on lip-reading, which becomes impossible through a mask. Many speak English as a second language which can make building rapport especially difficult.

No matter these barriers to communication, a smile is universal, Kingston notes.

 “We are in an in unprecedented time where we have to look outside the box and find alternatives to improve the patient experience. The isolation patients feel is tremendous and for many, they are not able to express their emotions,” Kingston said. “I want my patients to feel important, to feel heard, and to feel included in the plan of care.”

In addition to her current role as a bedside registered nurse, Kingston is also a licensed social worker. For 32 years, Kingston has focused on providing holistic care to vulnerable adults in acute care and medical settings across the Twin Cities. The depth and breadth of her past experience has helped her look at an individual patient’s needs through a different lens – one that is focused on the larger picture of that person’s illness trajectory.

“It’s easy for staff to forget that we do this work every day,” Kingston said. “But for our patients, hospitalization is a major stressor. I think one of the most important things you can do is to meet patients where they are at in their life’s journey. We all come from different backgrounds and you just never know what challenges an individual has been through in their life that brought them to you.”

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