Covid-19 Reflections – ‘through the visor’

Last month we shared with you a moving diary account, written by Senior Lecturer Denisse Levermore, of one of her days working on a Covid-19 ward.

Denisse, who lectures on the University’s Child and Adolescent Mental Health degree, has penned a second fascinating piece reflecting on how she’s had to adapt her ways of communicating with patients who now only see her ‘through the visor’.

‘Don’t raise your voice, stop waving your hands…’, I was told as a student nurse back in the day. Covid-19 has meant that this is one of the only means of communicating with your patients when wearing a face mask and visor. The first time I wore this PPE it felt unreal, wasn’t happening and I thought how frightening I must look and did feel towards vulnerable, scared patients. Fast forward a few weeks and now I can’t imagine not wearing this get up, this life saving protection, this politically charged and loaded PPE.

I care for my daily visor lovingly, write my name on it, clean it delicately and thoroughly inside and out at least 30 times per shift, I carry it like a precious handbag and worry if I misplace it for a short while – my visor has become my armour and I feel undressed without it……how did we get here?

All the patients see are our eyes. Every other part of the face is covered so how do we convey emotion when we can’t see a smile or a grimace? Body language, gesticulating or talking loudly become the norm. Within my lecturing role I teach therapeutic communication and counselling skills and pride myself on my excellent communication skills, but this is a big test. Touch is another form of communication that is misaligned in the world of nursing a patient with Covid-19. Emotion is also conveyed by touch and that is restricted by gloves, by distance, by infection control and by fear.

So how does a nurse demonstrate that they care, that they hear you and that they are with you every step of the way. Ultimately it is selfless and intuitive, led by a complex knowledge and understanding of the human body, disease and its effects but underpinned by an unconditional desire to care and get you well. Communication does happen by any means necessary and I have never used body language in the way that I do now, at times I wish I could see what my patients see of me. To see the world from their eyes is crucial to understanding what is said and unsaid and sometimes the unsaid is the most important to hear.

Spending more than 20 minutes in a face mask and visor is quite claustrophobic; the face mask needs to fit tight to your face to protect you and prevent your breath from fogging the visor – I discovered this to my peril, after a particularly challenging session washing a patient which by the end I could hardly see him. But when the mask is on tight and with a visor on top it is important to regulate your own breathing as the mask draws in when you breathe. I have not worn an FFP3 mask yet but am aware they are very tight as I have seen a physio with marks on her face after wearing one for 20 mins so straps are tight but potentially breathing through it is easier??

Fear is ever present in my communications these days and fear can be seen and heard, seen in the eyes of patients struggling to breathe, heard in the voices and tears of relatives whose only knowledge of their loved ones comes from conversations with you by phone. My role involves seeing, hearing and acknowledging that fear but also looking for hope, for a glimmer that will make a difference, however small, bringing some ‘normal’ to a very ‘abnormal’ situation. My own fear is ever present but is in the main unexpressed and unheard, colleagues and writing helps but there is a need, when things are different, to process different and difficult communications and the emotions that underpin them, as the visor doesn’t just suppress communication…

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