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COVID-19 Practicum Project

Jordynn Towner

Delaware Technical Community College

Cherry Golden

November 20, 2020

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COVID

COVID-19 is an infectious respiratory virus caused by a new member of the coronavirus

family, SARS-CoV-2. This virus has been the cause of a global pandemic that started at the end

of 2019 and is continuing through 2020. Individuals with exposure to COVID can develop

symptoms up to two weeks after the exposure. Reported signs and symptoms include shortness

of breath, cough, fever, fatigue, body aches, sore throat, nausea, vomiting, diarrhea, headache

and loss of taste or smell (CDC, 2020). COVID-19 infections can range from mild and easily

managed at home, to severe and needing hospitalization. Those individuals that are

immunocompromised or suffer from certain chronic illnesses, such as COPD, are at a higher risk

of complications from contracting this virus. Preventing the spread of COVID-19 has taken on

many forms, including increased education about handwashing, requirement of individuals to

wear masks in public and social distancing. Different countries and states have implemented

their own specific regulations in regard to those prevention strategies, and a closer look at

Montana’s COVID prevention strategy will follow.

COVID-19 in Montana

Montana is the fourth largest state in the country and has a population of just over one

million people. This state experienced their first COVID-19 case on March 11, 2020 and

currently have 50,582 cases statewide. The largest increase in cases has occurred in October

2020, Montana’s Department of Public Health and Human Services reports “The largest

increases of new cases occurred in October with more than 3,600 cases reported during the first

week of that month and more than 4,200 during the second week” (DPHHS, 2020, para 4). When

COVID cases are examined in reference to age groups, those aged 20-29 make up most of the

cases at 22% (DPHHS, 2020). This is followed by those aged 30-39 years old, with 50% of the
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total cases in Montana occurring in individuals ages 23-55 years old (DPHHS, 2020). Currently,

the state is hospitalizing 742 COVID patients, the median age being 65 years old, and has had

561 deaths (DPHHS, 2020).

Montana COVID Mandates

The first step Montana took to stop the spread of COVID-19 was a stay at home

directive, which took effect on March 28, 2020 (Montana Government, 2020). This action

required residents to remain at home as much as possible, prohibited gatherings of any size and

closed all non-essential businesses. The stay at home order lasted until April 10, 2020, then the

state began implementing COVID mandates that had been broken down into three main phases.

Phase One began on April 26, 2020 and required that all restaurants, bars, retail businesses,

gyms, casinos, places of worship and movie theaters operate at a 50% reduced capacity

(Montana Government. (n.d.). It also required physical distancing between non-household

members while in public, outdoor recreational activities were allowed to continue if distancing

protocols were followed. All assisted living and senior living facilities were not allowing visitors

and were screening staff prior to allowing them to work. Working from home was encouraged,

but if it was not possible steps such as closing common areas, alternating work schedules and

minimizing travel were recommended.

Phase Two began on June 1, 2020 and allowed for an increase in gathering size, with an

emphasis on maintaining social distancing. All the businesses listed in Phase One were now

allowed to operate at 75% capacity and gatherings of up to fifty people, with proper social

distancing, was permitted (Montana Government. (n.d.)). Child care facilities could increase

their capacity, but assisted and senior living centers were still not allowing visitors. Working

from home is still encouraged, and the Montana National Guard reserves the right to assess
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anyone traveling into the state for COVID signs and symptoms. This phase also included the

introduction of mandatory mask requirement, which began in July 2020 and is required in all

counties with four or more active COVID cases. Phase Three, which hasn’t been reached yet,

allows businesses to operate at full capacity again with full staffing and lifts all restrictions on

sizes of gatherings allowed, though social distancing is still recommended. Assisted living and

senior living facilities will allow visitors and travel restrictions will ease. Frequent hand washing,

sanitation and social distancing are still strongly encouraged.

COVID and the Elderly

Every population has been affected in one way or another by COVID and the mandates

that have been put into place, but one of the most vulnerable populations during this pandemic is

the elderly. The body’s immune system weakens with age, leaving the elderly with an increased

chance of contracting COVID-19. A weakened immune system combined with comorbidities can

lead to deadly consequences if this virus is contracted. With the mandates that have been put in

place to stop COVID, it may leave many elderly individuals feeling isolated and lonely due to

living alone, living in facilities that aren’t allowing visitors or trying to decrease interactions as a

safety precaution. Seniors may find it difficult to obtain the supplies they need due to dwindling

stock on store shelves, combined with restricted public transportation and an effort to limit

outings in public.

On a state level, there are not any COVID-specific assistance resources that are readily

found to help senior citizens, but the Montana government has a section on their website

dedicated to resources for those particular citizens. Located on the Department of Health and

Social Services page, is a section specifically for seniors, that includes information and resources

regarding nutrition, insurance, pharmaceuticals, long-term care and home health. The nutrition
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tab is of utmost importance because it includes information about congregate meal programs and

home delivered meals, in case COVID has deterred the individual from shopping or needed

supplies cannot be found. There is also information about a Personal Assistance Program, this

service assists with activities of daily living and can help with some shopping and housekeeping.

This program may be beneficial because of the isolation factor due to COVID.

On the national level, there are COVID-specific resources for older adults that can be

located through the National Council on Aging website. Included is information about obtaining

meals through home delivery services, locating transportation in their area, and programs that

can offer assistance with bills. There is also information about options if one does not want to

vote in person and hotlines for those suffering from a mental health crisis. This information is

crucial for the elderly population to receive during this pandemic, it just may need to be

distributed in another way as well because not all older adults are comfortable with the Internet.

Delaware COVID Mandates

Individual states have been responsible for creating their own mandates to slow the

transmission of COVID, though underlying themes are similar throughout. An examination of

Delaware’s COVID mandates and a comparison to Montana’s mandates will follow. Delaware

also began with a stay at home order that started March 24, 2020 and ended May 31, 2020,

lasting much longer than Montana’s order. Delaware’s Phase One began on June 1, 2020 and

ended on June 14, 2020 and appeared to be much stricter and shorter than Montana’s Phase One.

According to Delaware’s Phase One, restaurants, malls, hair salons, gyms, places of worship and

retail businesses are allowed to operate at 30% capacity and must allow for social distancing

(Delaware gov). Sports and outdoor activities were allowed when following social distancing

guidelines, though playgrounds remained closed. Child care facilities were only allowed to open
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if they were an emergency child care site and were open for essential employees. Casinos and

racetracks were closed, along with sporting venues, water parks and convention centers.

Phase 2 began on June 15, 2020 and Delaware is still currently in that phase, and the

same goes for Montana. Phase Two allows restaurants, malls, hair salons, gyms, places of

worship and retail business to now operate at 60% capacity. Child care centers are now

accessible to everyone and not just essential employees. Casinos, convention centers, pools and

summer parks are allowed to open. Gatherings are allowed up to 250 people, both indoors and

outdoors, as long as social distancing can be maintained. Delaware’s mandatory mask regulation

began on May 1, 2020 which was about 2 months prior to Montana making masks mandatory.

Delaware’s policy regarding visitation in assisted living facilities started with no visitation,

progressed to outdoor only visitation and is now allowing indoor visitation by appointment in

facilities that haven’t had new COVID cases in at least the last 14 days. Overall, Delaware’s stay

at home order began earlier and lasted longer while Montana entered Phase One quicker, both

states currently remain in Phase Two. Montana allowed businesses to operate at a higher

capacity during both phases, but Delaware allowed larger gatherings, with social distancing, to

occur. Both states are encouraging working from home, limiting travel for leisure and staying

home if you are a member of a vulnerable population.

Role of the Nurse

One of the main roles of a nurse is to provide patient-centered care, and the presence of

COVID does not change that. Nurses are responsible for caring for patients with COVID, those

who think they have COVID, and for providing education regarding COVID. Nurses should

educate about what signs and symptoms can occur when one contracts COVID, under what

circumstances should one seek medical attention, and what precautions should be taken in order
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to prevent the spread of COVID-19. It is important for nurses to stay up to date on the most

current mandates in their states so that they are not only able to educate their patients, but so they

are sure to be following those mandates themselves. It is also important for nurses to enforce

patients and families abiding by the mandatory mask mandates, when applicable. It might prove

beneficial to provide education about why masks are mandatory, as some individuals just view

them as an annoyance and do not truly understand the purpose.

COVID Questionnaire Analysis

In order to understand the effect of the COVID-19 pandemic on the local community, a

questionnaire was disturbed to 13 recipients that focused on some potential hardships one might

be facing during this pandemic. An example of the questionnaire is displayed below.

Figure 1 – COVID Questionnaire

The following questions are in reference to the COVID pandemic, the timeframe in question is
from March 2020 until now.

 Have you been out of work due to the COVID pandemic at any point since March?
o If so, for how long?
 Has your significant other been out of work at any point? If so, for how long?
 Has your job asked you to work from home, if possible, during the pandemic?
 If you have been going to work in-person has your job put any monitoring requirements
in place, such as taking temperatures before entering or mandatory COVID testing?
 If you have had to miss work due to a COVID exposure, pending test result, etc., did you
get paid for that time off?
 Was the COVID stimulus package a replacement for lost income or “extra” money for
you?
 Have you felt a financial burden at any point during the COVID pandemic?
 Do you use public transportation?
o If so, did you experience any related difficulties during COVID?
 Was your child care facility closed at any point during the pandemic?
o If so, who was responsible for watching your child?
o Did you have to miss work to watch your child?
 How often did you visit the grocery store prior to COVID? How often having you been
going since the pandemic began?
o Do you feel like you have tried to buy in bulk to limit visits to the store?
 Do you wear your mask in public at all times?
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 On a scale of 0-5 (0 being staying at home and interacting only with same household
members and 5 being going out frequently and interacting with everyone) how would
you rate your compliance with social distancing?
 What personal barriers have you experienced during this pandemic?

Recipients were asked to answer the questions with as much detail as possible and their

results were analyzed for similarities and common themes. The majority of respondents, 11 out

of 13, have jobs that are deemed essential and have not missed work due to the pandemic. The

two individuals who were out of work completely for a couple months, returned to their jobs

during Phase Two. Only 3 of the 11 individuals who have worked through the pandemic were

able to work from home, all other jobs required an in-person presence. Those that work from

home have been given the option to start returning to the office if they choose. Of those that are

going to work in person, it seems that only jobs in the medical field and school district are

requiring any type of COVID screening, such as temperatures, prior to work. None of the

respondents have spouses that have been out of work due to COVID. Since the majority of

respondents have kept working through the pandemic they responded that the COVID stimulus

package was considered “extra” money, most said they put it right into their savings. The 2

individuals who were out of work classified the stimulus as replacement for lost income. They

were also the only ones who reported feeling a financial burden during the pandemic, one saying

they had to reach into their savings to get by and the other reporting they borrowed money from

family. Public transportation was not used by any of the respondents, everyone uses their own

car to commute.

Two respondents reported that they utilized childcare facilities on a regular basis, they stated

they only experienced issues with childcare around March and April, back at the beginning of the

shutdown. During the stay at home order their childcare facility was closed, this meant they had

to find family members willing to watch their kids, the other option was their spouse or
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themselves taking off work to stay home. Both respondents state they did luckily have family to

help out with babysitting, but they did still have to miss work occasionally, the average being

once per week. All of the respondents reported that they went to the grocery store either weekly

or every 2 weeks prior to COVID. All respondents also reported that they have tried to change

their shopping habits, buying in bulk for example, in order to go to the store less frequently.

Respondents only reported this was an issue back when stores were running out of supplies, like

toilet paper, and they were forced to go to multiple stores more frequently in order to get what

they needed.

All 13 individuals wear their mask in public, though about half report they are tired of doing

so and wish that mandate would end. When asked about their social distancing practices, about

half reported themselves as a 1-2 while the other half reported they were a 4-5. Many stated back

in March they were much better at staying home and only interacting with those in the same

household, but as the quarantine has gone on and places have started to open up they have

become more relaxed. The age range of those who rated themselves 4-5 tended to be younger,

20’s and 30’s, and commented they would go out with their friends because they were bored.

That leads right into the final question, those in the younger age groups reported their personal

barriers to adhering to social distancing guidelines were boredom and missing their friends. The

other ones mentioned were missing family members, sadness due to disruption in regular routine,

weight gain due to gym closure, financial strain and finding appropriate child care.

Options for COVID Barriers

One of the most commonly mentioned personal barriers centered around the difficulties of

social distancing due to missing friends and family. This could be combated by offering and

promoting safe alternatives to in-person encounters. Some ideas could include FaceTime, Zoom
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calls, or socially distanced outdoor activities like hiking or a picnic. Having themed Zoom

meetings, such as happy hours or Taco Tuesdays, may help spike interest or having scheduled

meetings may give individuals something to look forward too. Reinforcing the social distancing

guidelines, wearing a mask and staying 6ft away from others, may help remind people that they

can see their loved ones and there is a way to do it to keep everyone safe. Another barrier

mentioned was finding childcare when facilities were closed, either by a mandate or due to a

COVID exposure. Options for this barrier could include employers providing childcare for

essential employees, employers providing a type of PTO day allotment for when individuals

can’t find childcare, allowing employees to work from home or allowing an alteration in work

hours to help with childcare coverage. Weight gain due to gym closure was another concern of

individuals, some were also weary of returning to the gym when allowed due to the sharing of

equipment. This could be countered by promoting at home workout programs, there are a variety

of free and subscription ones available on the internet and most can be modified to do without

weights if necessary. Another option is to promote outdoor activity, such as hiking in local or

state parks, which Delaware did when they waived the entry fee into the state parks. Friends

could create challenges on who can get the most steps per day to help promote activity, and this

could allow for exploration of new areas. The last personal barrier mentioned was the financial

burden due to being out of work. A possible solution for this predicament is the release of

another COVID stimulus package, or make getting unemployment easier to get for those who are

truly in need. Also, increased promotion of potential temporary jobs that are hiring for those who

are out of work. One idea that was not specifically mentioned, but that all these other topics

could impact, is an individuals’ mental health. This pandemic is a time of stress and uncertainty,
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and that can take its toll on one’s mental health. It is important to advertise mental health

hotlines, resources and places that individuals can go for help.

Conclusion

The COVID-19 pandemic has affected nearly everyone in the United States in some way or

another. States have been forced to create quarantine protocols in an attempt to stop the spread,

and healthcare workers have taken on the role of caring for those infected and educating others

on how to prevent infection. This pandemic has taken its toll on people in many ways;

financially, mentally and emotionally, and everyone has their own personal barriers they must

overcome. Overall, the most important things to remember are to wear your mask, practice social

distancing and stay safe.

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References

Centers for Disease Control and Prevention. (2020, May 13). Coronavirus Disease 2019
(COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/symptoms-
testing/symptoms.html

Delaware Government. (2020). Coronavirus Disease (COVID-19).

https://coronavirus.delaware.gov

Department of Public Health and Human Services. (2020, November). Coronavirus Disease 2019
(COVID-19).
https://dphhs.mt.gov/publichealth/cdepi/diseases/coronavirusmt/demographics

Department of Public Health and Human Services. (n.d.). Services for Seniors.
https://dphhs.mt.gov/seniors

Montana Government. (n.d.) Montana Reopening the Big Sky.

https://covid19.mt.gov/Portals/223/Documents/Reopening%20Montana%20Phase
%202.pdf?ver=2020-05-20-142015-167

Montana Government. (2020, March 26). Governor Bullock Issues Stay at Home Directive to
Slow the Spread of COVID-19. https://news.mt.gov/governor-bullock-issues-stay-at-
home-directive-to-slow-the-spread-of-covid-19

National Council on Aging. (n.d.). COVID-19 Resources for Older Adults & Caregivers.
https://ncoa.org/ncoa_acf/covid-19-resources-for-older-adults/