Table 2.

Themes (1–4), subthemes, and quotes related to family members’ stress while having a critically ill loved one during visitation restrictions and physical distancing

Themes/Subthemes	Quotations
Theme 1. Inpatient visitation restrictions generated deep, emotional personal anguish and suffering.
1A. Feared their loved ones felt isolated or would die alone	“Knowing that he was isolated, and he was by himself, and we couldn’t be there with him to remind him that he wasn’t alone.” (Spouse, WA) “The scariest part was just not being able to be there to explain to her what was going on.” (Sibling, CO)
1B. Yearned for physical presence and touch	“I think that having your family members there holding your hand, even though they can’t change the outcome, there’s– comfort.” (Child, WA) “We were there [on video], but we were not physically there for him. That was the hardest part of being in that room [but you can’t even] hold his hand for five minutes, and that’s all I was asking.” (Child, CO)
1C. Overwhelmed by guilt, helplessness, and decisional conflict	“I would drop things off for him and I wrote on the bag: ‘We are not abandoning you. We can’t visit you.’ It broke my heart. And I told the staff, can you please, please tell my parents that I’m not abandoning them.” (Child, WA) “The stress is really because, what if I make the wrong decision? What if I should have done something, and what if I make a decision that’s going to ultimately be harmful to her and not have the best outcome?” (Other relative, NY)
1D. Hard to advocate for their loved ones’ care	“My mom had dementia and COPD, which is why she was in the nursing home. And I could not advocate for her, like in two previous hospital stays…I was there and could actually interpret for her.” (Child, WA) “When you take away that extra support system for that patient, I feel like it might decline the patient a little bit quicker compared to if they had a support system there to advocate for them.” (Friend, CO)
Theme 2. The therapeutic relationship between family and clinicians suffered from fractured trust and ineffective communication.
2A. Struggled to take information at face value when they couldn’t see it for themselves	“We just had to believe whatever the nurse or the doctor was saying…I got so stressed out that I even asked one of the doctors to see a picture of him because I was doubting myself that he was still alive.” (Sibling, NY) “So it was really, really stressful because you were reliant on – and I’m not saying that clinicians are not truthful by any means – but you were relying on somebody else without being able to see it for yourself.” (Spouse, WA)
2B. Perceived circumstances would be different if they were there in person	“I almost felt like, if I’m there, they know who I am, maybe they’ll take better care of my dad… if they had a [face to the name] and they saw family and they saw how much he was loved. They would do everything in their power and make sure that he fights through this.” (Child, CO) “From a minority standpoint, there’s always been distrust with health professionals, especially ones that don’t look like us… I wanted to make sure that I at least knew and confirmed that he was under the right team’s care, and that they were going to prioritize his health at all times. It was important for them to see me.” (Child, NY)
2C. Goals of care conversations felt premature and pressured.	“I thought it was insensitive for the doctor to keep pressing me to give them permission to Do Not Resuscitate… knowing that the hospital had been on lockdown and knowing that the person probably hadn’t seen their loved one.” (Spouse, LA) “This doctor called me and said, I don’t think it’s a good idea to just give him oxygen because the chances of your dad of surviving is almost zero, so he’s just suffering… I was wondering if they are doing the right thing considering that they [already] think he’s a dead person.” (Child, WA)
Theme 3. Substantial psychological symptoms and illness were common in family members.
3A. Many described stress that manifested as physical symptoms.	“I couldn’t sleep. I lost weight. It was hard. I wouldn’t wish that on my worst enemy to go through that.” (Spouse, LA) “I’m very sensitive now to stress. It’s easier for me to have a panic attack from stress than it used to be.” (Guardian, NY)
3B. Some described experiences as traumatic, noted ‘triggering’ episodes	“Not able to touch him, hug on him when he did pass, was hard. I had to ID him a week after he passed. And that was really hard too because it’s like dealing with the trauma of losing someone to a violent crime.” (Child, NY) “There’s the flashbacks of everything happening and how hard this was. So, it all kind of just comes back at once sometimes.” (Child, WA)
3C. Some sought psychiatric care or medications.	“I actually entered a psychiatric unit. All of these experiences, much less the experience of having my spouse in the ICU and deathly ill and almost losing him, contributed to my breakdown.” (Spouse, WA) “I got some meds. I only took, like, a half a dose night. But that helped me.” (Spouse, WA)
Theme 4. Participants identified primarily positive coping strategies to address their distress.
4A. Many focused on maintaining hope and some semblance of normalcy.	“I tried to get out and get some exercise every day even if it was just taking a mile or two walk. That helps as well to deal with stress.” (Other relative, NY) “Just trying to take time to myself and just get my mindset back in a positive place. That kind of helps me a little bit.” (Sibling, CO)
4B. Family and faith were prominent sources of support.	“My church members and my pastors and ministers, they were calling me throughout the night. There was always someone to talk to me, pray with me, and keep me comfortable because I was by myself.” (Spouse, CO) “I have bereavement groups. I have a therapist. I’m taking antidepressants and medication for anxiety.” (Spouse, NY)
4C. A minority of participants used self-medicating strategies.	“Toward the second week of it, I would say I took a drink. And that seemed to calm me down. So, a drink a night just kept me calm.” (Spouse, LA) “And I can say this out loud because it’s legal. Cannabis kind of helped calm me down a little bit.” (Spouse, WA)

Definition of abbreviations: COPD = chronic obstructive pulmonary disease; ICU = intensive care unit.