District Nursing and Covid-19: The Show Must Go On
A blog by Zoe Horseman, Research Assistant and District Nurse.
During the Covid-19 pandemic in District Nursing, while the majority of the country stayed home to save lives, District Nurses across the country continued to deliver care in peoples’ homes. This presented new challenges to the service and gave opportunities for improvement.
The Covid-19 pandemic highlighted just how essential the District Nursing service is to the safety and wellbeing of housebound and vulnerable patients. With many other Community services withdrawing from home visits and opting to work online or from a distance instead, and family and friends stopping visits to loved ones in order to protect and shield, the District Nurses quickly became the only person that many patients would see in a day, or even a week. This led to an increase in the demands placed on District Nurses, as our already isolated patients became even more insulated from the outside world than before. I found myself assisting with more personal care to ‘bridge the gap’ when carers weren’t available, tidying homes, unpacking shopping, feeding cats and dogs, and even posting the occasional letter for my patients when they asked! These additional but fundamental tasks, coupled with clinical care and social interaction, formed the basis of a person-centred care delivery in the midst of a global pandemic.
At the onset of Covid-19, my team received some phone calls from patients and family members wishing to stop their District Nurse visits during the pandemic in favour of shielding more effectively, and to alleviate pressure on the service. This led to the challenge of teaching and supporting self-management via telephone with patients who have not self-managed their own care before and who have fears and anxieties about doing so. We found this to be quite successful. We now use a phone call, where appropriate, in place of a home visit to prompt some diabetics to check their blood glucose level and administer insulin, and we make weekly calls to support those living at home with a terminal diagnosis. Many family members took on the challenge of re-dressing wounds at alternative visits, reducing the need for the nursing staff to attend. As a District Nurse, I felt really proud of my patients and their families for their efforts to self-care, especially when many of them lacked the confidence to do this prior to the pandemic. Looking to the future there are lessons we can learn as a Service from the Covid-19 pandemic, particularly around encouraging and facilitating self-management of care, and sign-posting individuals to more appropriate services.
We faced challenges around provision and use of PPE, and the communication barriers associated with face masks. Equally, the introduction of social distancing measures meant that physical acts of kindness and comfort, such as a hug or holding a hand, were no longer appropriate, and we needed to draw on verbalising empathy and support instead. This was particularly challenging when providing end of life care, and together with patients and families we faced difficult decisions about final place of care and ways to facilitate seeing loved ones when the end was near. As a District Nursing team, we found ways to deliver person-centred care at the end of life, whilst navigating the risks of Covid-19.
The District Nursing service found new ways to provide the same high standard of care and support to our patients, despite the challenges presented during Covid-19. We need to learn from these new ways of working and adapt our practice in order to meet the needs of our patients in the future.