The COVID-19 pandemic is challenging the delivery of nursing care in every environment, not least within patients' own homes. This pandemic is having an impact that we would never before have imagined possible; apart from key workers, the entire population is locked down and socially distanced, and there are devastating nightly reports of tragedies, alarming mortality rates and upsetting reports of the loss of colleagues from all disciplines of healthcare.
Emergency departments and critical care units have rightly been the main focus of media attention; ventilators have been rapidly sourced, and new Nightingale Hospitals speedily developed. However, the ‘oft-forgotten’ care, delivered by community teams, in ‘wards without walls’, seems to have missed the spotlight, despite being essential and at the very heart of care provision for patients at home. District and community nursing teams provide complex, person-centred care, freeing up vital hospital beds and providing care for the now burgeoning ‘housebound’ population; this is alongside end-of-life care, wound care and support for patients with a range of complex conditions. Caseloads have expanded exponentially, with numerous, hurried hospital discharges, often with the added uncertainty of COVID-19 status. The withdrawal of routine face-to-face care by other services, the closure of ambulatory care and the stay at home directive have all added significantly to caseload pressures.
The non-clinical home setting presents many threats to personal safety for the community healthcare workforce. There is confusion and inconsistency in national guidance in relation to PPE alongside poor availability of PPE and a feeling that what is recommended is inadequate, especially within the home environment. Community staff have been heckled, abused and labelled ‘disease spreaders’ for travelling in uniform between visits. The use of family cars to travel between visits has never been so challenging; the transportation of clinical waste, returning home in uniform and training on donning and doffing are all processes complicated by the varied and often inadequate community environment in which our care is delivered.
Despite these challenges, there are many positives as a result of these essential changes to the way we are working. At no other time within our recent history has the tenacity, resourcefulness and compassion of community teams been so evident. Technology has come to the fore; online team meetings and virtual ‘huddles’ support care delivery, team working and staff morale. ‘Critically cleansed’ caseloads ensure care is delivered only where it is essential; self-care has increased, with support for patients from extended families, friends and neighbours. Some patients, ironically, are choosing to decline nursing visits, preferring to avoid any potential risks posed by clinical staff, and, as a result, are self-managing conditions like never before. This is an important takeaway from the ongoing crisis: caseload cleansing and person-centred care only for ‘appropriate’ patients should be the district and community nursing team mantra when things eventually return to normal.
District and community nursing teams are often an unseen workforce, and COVID-19 may well have raised their profile and that of the essential and complex care delivered behind closed doors. Their ability to continue to provide essential and life-enhancing care to those in their caseloads is inspirational and poignant. When this pandemic has abated, we need to ensure that nursing in the community effectively capitalises on these positives—enhanced supportive team working; deployed colleagues supporting community teams; effective, successful promotion of self-management; the delivery of care and medication by family members; and integration of new technologies. Indeed, there will be much to learn for us all as a new world emerges.