The COVID-19 pandemic has impacted our lives in unprecedented and dramatic ways that few could have imagined. At the time of writing, the number of new cases has been broadly falling, and a much-needed development around the use of dexamethasone for the most seriously ill patients has come to light (BBC, 2020). The worst may or may not be behind us-time will tell.
Looking forward, the community nursing profession will face enduring patient health issues, which, regardless of a ‘second wave’ recurrence, will need managing. Specifically, this will involve aftercare and support for those with long-term symptoms after acute COVID-19 recovery and the managing the repercussions of suspended health and social care for many other conditions.
During the pandemic, primary care and community nursing professionals, although less medianewsworthy, have supported people who do not require hospitalisation for COVID-19, alongside the most vulnerable people in our communities. Community nurses have faced challenges around a lack of personal protective equipment (PPE), lack of testing for staff and severe and chronic workforce shortages. There is general agreement that things cannot go back to being as they were. After hospitalisation-which for some, included several weeks in intensive care-COVID-19 patients will have to undertake a long recovery journey. New guidance from NHS England (2020) sets out an extensive and sobering list of the physical, psychological, neuro-psychological and social implications termed as ‘post-intensive care syndrome’. Patients and families affected will require long-term home support from a system that is already stretched.
So, what does this mean for community nursing and how can these challenges be addressed? The NHS England report (2020) emphasises the need to provide normal care but identifies four new additional challenges:
Issues around infection control, pressures on equipment and managing persistent psychological difficulties linked to enduring and long-term illness are not new for community nurses. However, the context and difficulties linked specifically to COVID-19 need careful consideration. There might be upskilling education needs within community nursing teams. The psychological impact of COVID-19, delays in treatment for people with illnesses such as cancer, organ failure and regular monitoring of long-term conditions are all likely to be profound, and community nurses will be the key contact for many. There is also a need for excellent cross-sector and multidisciplinary working to ensure the right care and support can be offered at the right time.
Very importantly, staff support-now and in the future-will be critical. Staff are at increased risk of contracting the infection themselves or passing it to others, including their own families. Lockdown restrictions are likely to have affected important support networks, such as families, schools and nurseries. The economic impact of COVID-19 may felt by close family members. Many staff will experience both personal and professional grief as a direct result of this pandemic.
Caring for the carers, both professional and informal ones (who provide substantial support at home) is critical if we are to manage this ‘new normal’ in community nursing. Challenging times lie ahead. Fostering resilience in community nurses requires resources, recognition and adequate support for the personal challenges they face amid these extraordinary times, and beyond.