As the COVID-19 pandemic was rapidly spreading in Northern Italy during 2020 Spring, the resources of intensive care units were soon inadequate to face the number of patients who were in need for intensive and specialized care in hospitals. At the same time, the work-related and emotional burden of healthcare specialists dramatically raised as a real issue. In this context, young medical residents in child neuropsychiatry of the IRCCS Mondino Foundation / University of Pavia (Italy) volunteered to support their senior colleagues in different COVID-19-designated hospitals in Lombardy.
In a recent paper published in Academic Psychiatry, we report on their experience highlighting what they did, why it was important, and how they were rewarded in terms of career and personal growth. A phenomenological, qualitative approach using semi-structured interviews with open-ended questions was used to obtain in-depth narratives of the experience of residents in child neuropsychiatry volunteering in North Italy COVID-19-designated hospitals. These interviews revealed specific core themes.
“Once a patient entered into the COVID unit, she disappeared from the rest of the world [...] The most fragile leaves were falling, and no one was there to catch them before they reached the floor”
First, young medical residents were involved in indirect care actions, mainly facilitating communications between patients and professionals, as well as between patients and their relatives. In an emergency and intensive care setting where priority is given to grant survival, they improved the humanization of care, granting opportunities for connection. Second, they were exposed to the shock of dealing with patients' death. While this is pretty uncommon in their usual training setting - child neurology and psychiatry units - caring for patients who were extremely fragile was a shocking experience. Volunteer residents also took responsibility for collecting personal belongings of deceased patients and returning them to their relatives, thus closing a circle of empathy and mourning. Third, their education provided specific skills to deal with the relational and psychological needs of the patients. Fourth, these skills also improved in a context in which learned abilities and personality predispositions were mixed up to provide patients and their families with the best human and medical care possible. Fifth, they were able to acquire a deeper sense of the role of psychological and emotional dimensions of medical care. Something that they will be able to keep and deliver in non-intensive rehabilitation settings with pediatric patients.
“There was no protocoled way to do this (…) too many factors were outside of our control [...] I was afraid of not being up to it [...] Feeling guilty for the simple fact of being afraid, as if fear were not something that should have been allowed or possible”
This experience may offer relevant insights for the future engagement of neuropsychiatry residents as a key resource in healthcare emergency management. In the experiences here examined, residents asked to be assigned “on the run” and based on their own initiative. In views of other possible waves of this pandemic – or of future healthcare emergencies – these findings may contribute to plan the involvement of child neuropsychiatry residents in advance, in order to allow for their assignment to high-need contexts.
Parravicini, S., Provenzi, L., Barello, S., Nania, T., Grumi, S., Rinaldi, E., Orcesi, S., & Borgatti, R. (2021). The Experience of Child Neuropsychiatry Residents who Volunteered in Italian COVID-19-Designated Hospitals. Academic psychiatry. Doi: https://doi.org/10.1007/s40596-021-01442-x