I am writing this commentary to bring to readers’ attention a medical and ethical complexity related to human sitters for presumably suicidal, COVID-19–positive hospitalized patients.
Dr. Elspeth Cameron Ritchie
To shape and bundle the ethics issues addressed here into a single question, I offer the following: Should policies and practices requiring that patients in presumed need of a sitter because of assessed suicidality change when the patient is COVID-19–positive? Although the analysis might be similar when a sitter is monitoring a Patient Under Investigation (PUI), here I focus only on COVID-19–positive patients. Similarly, there are other reasons for sitters, of course, such as to prevent elopement, or, if a patient is in restraints, to prevent the patient from pulling out lines or tubes. Again, discussion of some of these ethical complications is beyond the scope of this piece. Just considering the matter of potential suicidality and sitters is complex enough. And so, to start, I sought out existing sources for guidance.
In looking for such sources, I first turned to the Centers for Medicare and Medicaid Services before COVID-19. CMS has required that there be a sitter for a patient who is suicidal and that the sitter remain in the room so that the sitter can intervene expeditiously if the patient tries to hurt himself or herself. There has been no change in this guidance since the COVID-19 pandemic in the United States. To the best of my knowledge, there is no substantive guidance for protecting sitters from contagion other than PPE. Given this, it begs the question:
In my hospital, I already have begun discussing the potential risks of harm and potential benefits to our suicidal patients of having a sitter directly outside the patient’s room. I also have considered whether to have one sitter watching several room cameras at once, commonly referred to as “telehealth strategies.”
To be sure, sitting for hours in the room of a COVID-19–positive patient is onerous. The sitter is required to be in full PPE (N-95 mask, gown, and gloves), which is hot and uncomfortable. Current practice is resource intensive in other ways. It requires changing out the sitter every 2 hours, which uses substantial amounts of PPE and multiple sitters.
Regardless, however, there are really no data upon which to base any sound ethics judgment about what should or should not be tried. We just have no information on how to attempt to balance potential risks and prospects for the benefit of whom and when. And, given that good clinical ethics always begin with the facts, I write this piece to see whether readers have thought about these issues before – and whether any of clinicians have started collecting the valuable data needed to begin making sound ethical judgments about how to care for our presumably suicidal COVID-19–positive patients and the sitters who watch over them.
Dr. Ritchie is chair of psychiatry at Medstar Washington Hospital Center and professor of psychiatry at Georgetown University, Washington. She has no disclosures and can be reached at [email protected].
This column is an outcome of a discussion that occurred during Psych/Ethics rounds on June 5, and does not represent any official statements of Medstar Washington Hospital Center or any entity of the MedStar Corp. Dr. Ritchie would like to thank Evan G. DeRenzo, PhD, of the John J. Lynch Center for Ethics, for her thoughtful review of a previous draft of this commentary.
I just had to room sit for a COVID positive patient for 8 hours yesterday. They didn’t tell me the patient had COVID and pulled me off another floor, where I was working as a tech. All they said was that I could prob get off early and that it was not a dangerous patient. I got to the floor and it was a COVID room. I’m new so I didn’t speak up. Then- they left me for 8 hours. I did get a couple of breaks one 15 minutes one 1/2 an hour. At the end of 8 hours I asked to be traded out and the charge nurse threw a fit- she said that nobody else had ever been asked to be traded out of a COVID room and made a huge deal about it. I was shocked it was horrible. Def writing a letter to HR. that wasn’t right. I won’t give any details about the patient but the person did have an occasional persistent cough and didn’t have a mask on.
I am a high risk sitter. I refused to sit in Covid 19 positive rooms because by CDC guidelines I am hgh risk. My employer doesn’t agree with my decision. What can I do to protect my own health and keep my job.
Aren’t we all human, and as nurses don’t we pledge to care for the sick. What about the patient in the room with a sitter who may be COVID positive. Isn’t that also possible? What has COVID got to do with anything? We all must have lost our education how to prevent disease and put on PPE. How all of the sudden did we forget that we are nurses?!?!
I know that I am late to this conversation but the nurse would not be the person that would watch the patient in this situation; it is the nurses aid/or a patient sitter. Yesterday we had to rotate sitting in a covid room because the patient assaulted a staff member and he was put in restraints. As I was sitting in the room, all I could think about is the fact that I make 15.30 an hour to sit in a room with a “person” that harmed one of my coworkers, spit at me, all while calling us names. I value our nurses but the CNA’s/PCA’s and even paramedics have been lost in the shuffle and while the nurses were being called heros and advocating for themselves, the staff that supports the nurse doesn’t even get paid a living wage.
I know that the writers article isn’t about an aids pay but I want to organize a change but I don’t know where to start. I graduate nursing school soon but this needs attention.
Thank you for giving my response your time.