District Nursing in the Time of Covid-19

These are the strangest of times and probably the most unusual I have worked in as a District Nurse.

When it became clear that the NHS would be forefront in dealing with this virus we quickly began to prepare for the unknown without really knowing what to expect or how it would affect us as a team.

Our first action was to look closely at our caseload and make decisions about visits that we felt family or carers could be encouraged to manage, there was some resistance from some families but the majority were keen to help and more importantly help keep their relatives safe.

We spent time with these families and carers, particularly in the various care homes, teaching them basic wound care, how to take blood glucose readings and even how to administer insulin.

A small group of our vulnerable patients were sent shielding letters or decided to self-isolate themselves and we’ve kept in regular telephone contact with these patients and dropped off any supplies they might need on their doorstep, often accompanied by a wave through the window.

As time has gone on the anticipated influx of patients to our corner of Community Nursing hasn’t happened, at least not yet. We keep getting told the peak hasn’t hit us yet!

Whilst we aren’t getting any routine referrals such as post op care we have seen a sudden rise in palliative and end of life care and have had clusters of deaths both in our care homes and within patients homes.  These referrals are often for previously unknown patients but also for patients who have previously been quite well.

The visits to set up syringe pumps and manage their last few days has been challenging for us all; we have little time to build up any relationship with family members – if at all as many homes have been restricting family visits. If family are present we are dealing with their anxiety and confusion as well, seeing their loved one deteriorate so quickly and needing drugs such as Morphine is very hard for them to understand and it is hard not being able to give them the answers they need.

As senior nurses we are now able to verify expected deaths and I have done this a couple of times so far, the hardest part for me is not being able to offer any physical comfort where appropriate such as a hug or squeeze of the hand. A virtual hug just doesn’t seem right and with our face masks on it makes it all seem very impersonal and too clinical.

Up to now there has been little or no testing of patients within the community; in the early days of this crisis patients were being discharged home without having been tested, and elderly patients unable to go home were being placed into beds in care homes often without us knowing if they were positive for the virus or not.  Sadly we can only surmise what has caused their sudden decline.

My team has also had several new members of staff join us, in ‘normal’ times we would be taking them out with us in our cars but this is now not possible; trying to be mindful of social distancing in the office means we are sending staff home once their work is done so any coaching or training of staff is reduced.

We are all working hard together, our Trust is looking after us very well in my opinion; we are provided with sufficient PPE and also with meals when on duty.

It will be a long period of reflection once this is passed and a re-evaluation of roles going forward.

Claire Green

District Nursing Sister/ CPT / Queen’s Nurse