Following the pandemic shutdown, my hospital resumed elective surgeries. Some patients have been reluctant to have surgery for fear that they will contract COVID-19 in the hospital. How can I assure patients that their safety is our primary concern, and we are enacting all necessary measures to decrease COVID-19 transmission and promote optimal health?-JS, COLO.

Christopher H. Stucky, PhD, RN, CNOR, CSSM, RN-BC, NEA-BC, replies: The COVID-19 pandemic response last spring caused an unprecedented disruption of routine services in healthcare systems worldwide.1 Many hospitals canceled elective surgeries during peak disruption to limit the spread of the virus, conserve personal protective equipment (PPE), and enable clinicians to assist with the pandemic response.2 Secondary repercussions from the pandemic affected COVID-19-positive and non-COVID patients alike as the limitations to surgical procedures and outpatient visits reduced access to care for millions of patients.3

The direct and indirect consequences of delaying surgical treatment and outpatient visits are high, as the burden of disease continues to accumulate. In addition, the decline in outpatient primary care office visits potentially decreases the prevention and early diagnosis of many surgical and health-related issues. Delaying surgery allows diseases to progress, potentially reducing optimal health outcomes and making surgeries more complicated and costly.4

As state officials eased restrictions on nonurgent and elective surgeries, many hospitals enacted strategies to increase capacity and reduce surgical backlogs.5 The decision to resume elective surgeries occurred at a pivotal time when many healthcare consumers had become acutely aware of the pandemic's severity. This made many afraid to seek necessary care.6

Regardless of the COVID-19 pandemic, presurgery anxiety is normal, but surgical patients may now have additional anxiety concerning the perceived risks of contracting COVID-19 while hospitalized. National medical, nursing, and hospital organizations have provided clear guidance for safely restarting and maintaining elective surgeries during the pandemic.7 However, there is limited guidance for perioperative nurses to decrease pandemic-related patient stress and fear concerning surgical procedures. Thus, nursing and perioperative leaders can use the pandemic as an opportunity to communicate to patients that accessing surgical care is both safe and essential to their optimal health.

Perioperative nurses can educate patients about the safety and efficacy of surgical care during the COVID-19 pandemic by:

* finding creative techniques to communicate with patients, including a wide array of virtual and electronic services. Relaxation of certain laws and regulations during the pandemic gives perioperative nurses new opportunities to connect with patients outside of the hospital setting and monitor preoperative and postoperative health.8 For example, depending on patient needs and facility policy, healthcare professionals may use remote communication technologies such as FaceTime, Facebook Messenger, Google Hangouts, Zoom, or Skype, for telehealth services.9 Telehealth provides a new medium for nurses to educate patients, preserving preoperative and postoperative patient-care continuity and reducing nonessential hospital foot traffic. Regardless of how they communicate, nurses should assess patient learning styles and preferences, keeping in mind that some patients are experiencing information overload from a persistent stream of COVID-19 guidance.

* explaining hospital measures to ensure safe and reliable care. Nurses must be able to communicate their hospital's COVID-19 strategic plan and strategies enacted to decrease transmission risk, including active screening and testing procedures, PPE requirements, infection prevention and control considerations, physical distancing measures, and negative pressure rooms. Some facilities have developed dedicated COVID-19-free surgical pathways to further reduce risks.10

* reassuring patients that hospital COVID-19 policies and procedures follow global, national, and state guidance and recommendations from leading nursing and medical associations. For example, nurses should alert patients to the facility mask policy and explain that their healthcare team will communicate with them while wearing PPE, including masks (N95 respirators and/or surgical masks) and potentially eye protection.

* discussing with patients what to expect before, during, and after surgery. Nurses can alleviate patient stress and anxiety by discussing with patients how COVID-19 impacts their surgery and what to expect throughout the continuum of care.

* discussing COVID-related operational changes, including restricted visitation for surgical and nonsurgical patients, touchless check-in systems, changes to patient waiting areas, enhanced room cleaning protocols, and the potential for anesthesia recovery in the OR.

* sharing credible and reliable COVID-19 information sources. Health literacy is important to prevent the spread of communicable diseases and improve overall health.11 Discharge instructions should include information about COVID-19 signs and symptoms as well as surgical complications.

As the pandemic progresses, growing knowledge and innovation can produce conflicting and quickly changing guidelines. Patients should know where to seek credible and reliable healthcare information to stay current and make informed health decisions. Refer healthcare consumers to credible resources for COVID-19 information (see Resources for patients).

Resources for patients

* Centers for Disease Control and Preventionhttp://www.cdc.gov/coronavirus/2019-ncov/index.html

* National Institutes of Healthhttp://www.nih.gov/coronavirus

* US Department of Health and Human Serviceshttp://www.hhs.gov/coronavirus/news/index.html

* World Health Organizationhttp://www.who.int/health-topics/coronavirus

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