Abstract
Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization in March 2020. Caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, its high transmissibility required infected individuals to be placed in negative pressure isolation rooms when admitted to intensive care units (ICU). Studies have shown that limited social support can increase the risk of developing delirium during ICU stays. Minimal research exists on COVID-19-associated ICU delirium as hospitals and government organizations focus on combating equipment shortages and case surges. Here, we present the case of a 64-year-old Filipino male with COVID-19 ICU delirium status post-intubation and ventilation. His hospital course was complicated by the medical staff's assumption that the patient spoke Spanish and improved after being assigned a Tagalog-speaking nurse who facilitated family communication. This case highlights the importance of cultural competency and communication in the management of COVID-19 associated ICU delirium. In particular, Filipino cultural practices and their intersection with healthcare in the larger context of providing culturally competent care are highlighted. The use of culturally competent care serves to assure the use of appropriate services and reduces the occurrence of medical errors due to misunderstandings caused by differences in language or culture. Familial involvement is critical for ICU delirium; however, the COVID-19 pandemic has required healthcare providers to think beyond conventional means. The use of technology to virtually communicate with family also serves as a helpful tool to treat signs of delirium. As seen in this case, a lack of understanding of the Filipino culture resulted in assumptions on the part of the healthcare provider which led to the prolongation of delirium in a COVID-19 ICU patient, but the correct utilization of cultural competence helped the patient recover successfully.
Highlights
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, first emerged as a public health threat in December of 2019
Surrounded by faceless, masked personnel covered in protective equipment and a lack of family and supportive services that usually act as patient advocates and assistants during episodes of delirium, recovery from COVID-19 intensive care units (ICU) delirium has been found to take longer than classical ICU delirium [7]
When working with COVID-19 patients of a different culture throughout the pandemic, it is important for healthcare providers to accurately apply cultural competence to reduce the risk of, and ameliorate, ICU delirium
Summary
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, first emerged as a public health threat in December of 2019. COVID-19 nasal swab with reverse transcriptase polymerase chain reaction (rtPCR) was done on hospital day two, which returned positive on hospital day four During this time, the patient began to deteriorate, progressing from using a nasal cannula and non-rebreather mask to requiring intubation and mechanical ventilation. Propofol, and midazolam were used for comfort in addition to a trial of hydroxychloroquine He was extubated on hospital day 23 after showing several days of marked improvement in oxygenation. A Tagalog speaking nurse or nursing assistant was assigned to the patient to facilitate cultural communication regarding the patient’s health care and wishes During this time, the patient was able to emphasize the importance of family and obtained a tablet to video call his wife and daughter, which resulted in a decline of delirium symptoms. The patient was discharged from the acute rehabilitation facility after 10 days with full recovery at home
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