When word came in mid-March that a nurse on his team would be the first in Northern California to visit a patient with the COVID-19 virus at home, Gio Cajanding knew there would be fear and anxiety.
The virus, which killed over 100,000 Americans in less than 6 months and has infected more than 11,000 health care workers in California, was at the time spreading unabated in the San Jose area where Cajanding serves as Kaiser Permanente director of Patient Care Services for Home Health and Hospice.
“We had 3 days to put a plan together, so the COVID-positive patients became very real for us,” said Cajanding. “At the time, everyone was afraid of being sent to a positive patient’s home and contracting the disease. But we also knew these patients are human beings who need to be taken care of.”
Cajanding and registered nurse Paivi Kinanen, who would see the first patient, put whatever fear and anxiety they may have had aside and called on their training, professionalism, and sense of purpose to get the job done.
As humans, we have our fears and our worries, but right now we have to push them aside, so we can be present for our patients.
As they developed their plan, which would now include a second person outside a patient’s home to help make sure the nurse was covered head to toe in protective gear, Cajanding and his team also reviewed their mindset.
Focus and Purpose
“We openly talked about the fear we had,” Cajanding said. “We talked about our patient, and why we were going there. We focused on our purpose and stayed with it, and that lessened the anxiety.”
Caring for a COVID-19 patient at home requires meticulous preparation to prevent transmission of the virus from the patient to the nurse or from the nurse to the patient. That means putting on and then taking off gloves, a mask, a face shield, and gown, all without touching anything exposed to the virus. The same precautions apply to physical and occupational therapists, who also see members in their homes.
Following general guidelines from infectious disease doctors, Cajanding and his team put together a COVID-19 playbook for seeing patients at home. A patient’s home is an uncontrolled and at times unpredictable environment as opposed to a hospital or doctor’s office, so the group brainstormed scenarios they might encounter that would put the patient or the nurse in danger.
Then they rehearsed.
“Knowing that we would be taking all the necessary precautions, I was very comfortable doing it,” said Kinanen, a Finland native who began her career as an emergency room nurse in 2007. “It was actually very exciting and interesting. I’m a nurse, and protecting myself from potentially harmful microbes is already built in.”
Their visit went well, and their patient recovered.
“That was our first visit, and it was successful, so it really motivated our staff,” Cajanding said.
Since March, a regional COVID-19 playbook has been shared across Kaiser Permanente Northern California. Now nurses are being trained on how to administer a COVID-19 test inside a patient’s home.
Chinelo Ahamefule, a home health nurse in Oakland who recently received training on the in-home tests, is ready to use the lessons her colleagues have prepared for her when it is her turn to see a COVID-19 patient.
“For the health care workers right now, there is this huge responsibility and expectation to be brave in the face of disaster,” she said. “As humans we have our fears and our worries, but right now we have to push them aside, so we can be present for our patients.”