Barbara Schwerin Bohus, MS, CCC-SLP, veteran hospital-based speech-language pathologist (SLP) has devoted her long career to patients, staff and students in training. She has served as vice chair or chair of the NJSHA Health Care Committee for more than 10 years and has been an advocate for patients as well as SLPs regarding legislative and practice issues. Barbara has served as the ASHA appointed State Advocates for Reimbursement (STAR) and the State Advocate for Medicare Policy Network (StAMP) representing New Jersey since 2003. As supervisor of speech-language therapy in a New Jersey hospital, Barbara has encountered many challenges during the COVID-19 pandemic. We are grateful for her service and want to share with you what it has been like for SLPs working on the front line.
Q: How has your work as a hospital-based SLP impacted patient care during the COVID-19 response? What is the role of the SLP team?
The general public has recognized health care workers for all that they have done during the pandemic; however, most people don’t understand the role of an SLP and why one would be needed. Our essential job is to address inpatients with COVID-19 who have dysphagia. We did not know what type of swallowing deficits would occur secondary to this diagnosis. We quickly learned how weak these patients are. Patients had difficulty sitting up, feeding themselves and moving at all during eating/drinking. We kept a careful eye on their respiratory and heart rate. We dealt with high flow nasal cannulas and non-rebreather masks.
As the number of patients grew, so did the role of health care workers. Many therapists were deployed with changes in their shifts in order to work when and where they were needed. For example, they served as runners for nurses or helped with prone positioning of inpatients to improve oxygenation.
There has been so many changes in health care delivery. By mid-March, hospitals were no longer permitting visitors. It was eerie to go through the halls, filled only with hospital workers, as loved ones could not be there. SLPs and other medical workers were present in order for the patients not to be alone and to soothe them as best they could.
Q: What has been most impactful to you as you have been on the front line during this time?
The world quickly changed for the SLP in this unprecedented time. We had to learn immediately how to treat a COVID-19 inpatient. We learned the changes in donning and doffing PPE, such as how to wash our hands with our gloves on. At the beginning of all of this, hospitals were quickly developing policies and changing them according to the Centers for Disease Control and Prevention. There were new directives every day. This caused some fear and anxiety among the SLPs. Some professionals were concerned, as they never agreed to serve during a pandemic and were worried about potentially infecting their families and small children when they went home. SLPs needed to be brave, to walk into the inpatient’s room and to treat an inpatient while a roommate might be dying.
We are pleased to see that the balance is shifting in the hospital where I work in northern New Jersey. There are now more non-COVID-19 inpatients than COVID-19 inpatients. We have come to know a new normal. The hospital staff must have their temperatures taken before permitted to enter a building on the hospital grounds. New protocols and procedures are being formulated, for instance how to work with outpatients who have dysphagia, laryngectomies or tracheostomies considering that there is a risk of aerosolization. The upper aerodigestive track and when appropriate the lower respiratory track must be tested for COVID-19. The patient and the SLP must remain protected moving forward with proper PPE, i.e., face shields and gowns. Outpatient rooms need to be safeguarded from any aerosolization by being shut down and cleaned after treatments.
Q: Are there some positive outcomes you see as a result of this experience?
Teamwork is the most positive outcome. I watched a group of professionals come together to handle so much stress with more patience than during a regular workday in the hospital setting.
Initially, nurses entered newly made negative pressure inpatient rooms to complete dysphagia evaluations without complaint while SLPs looked through newly designed doors with glass windows to guide the nurses through the testing and to view the patients’ results. This method of testing was conducted until the SLPs were educated regarding donning/doffing of PPE and there was enough PPE available for the non-nursing staff.
Nursing aide assistants entered the patients’ rooms to assist the SLPs even before we had to request help with repositioning inpatients or needing supplies. Staff from Environmental Services had to clean inpatients’ rooms, and all health care workers helped with delivering items into patients’ rooms or making the rooms neater.
One of the most memorable moments were the clap-outs when patients were discharged from the hospital who survived COVID-19 including fellow peers on staff. It was wonderful to see police and fire departments along with the public expressing appreciation of the health care and essential workers. The recognition made me feel emotional with sentiments that I had bottled up inside.
Q: Who is your NJSHA hero?
It sounds cliché; however, my NJSHA hero is our president, Robynne Kratchman, for all of her work during this very difficult time. She is ensuring every area of speech-language pathology and audiology is recognized, and sharing how we are all impacted during this pandemic. Robynne is doing an excellent job of keeping the NJSHA website current and informative. She has the capacity to look at all facets of our field and find ways to create a positive impact on all NJSHA members.