Adistrict nurse is a registered nurse who has undertaken a Nursing and Midwifery Council (NMC) approved programme, to achieve an additional specialist practice qualification in district nursing (SPQDN) (NMC, 2022a). Nurses studying on an SPQDN course will be classed as students and often hold supernumerary status to support their development and learning. This may be full time, part time or as part of an apprenticeship approach (Queens Nursing Institute [QNI], 2023). During 2022/2023, there were 647 students enrolled onto SPQDN courses in the UK (QNI, 2023). The standards of proficiency for this qualification include seven platforms for learning, which encompass being a safe, autonomous practitioner. Nurses will plan and assess care needs using the evidence base, while promoting health and wellbeing, leading and supporting teams, and being proficient in quality improvements (NMC, 2022a). The NHS Long Term Plan (NHS England, 2019) identifies the district nursing service as providing vital nursing care to patients in their own homes, and in other community settings, as an integral part of the future strategy to boost out-of-hospital care.
Coronavirus disease (COVID-19) is a virus which causes a high temperature, muscle aches and sore throat (World Health Organization [WHO], 2023). It is caused by the SARS-CoV-2 coronavirus and is transmitted via close contact between people. People more than 60 years of age and with pre-existing medical conditions such as hypertension, diabetes and cancer have a higher risk of serious ill health or death from the virus (WHO, 2023).
On 11 March 2020, the WHO declared the worldwide spread of COVID-19 a pandemic (WHO, 2020). On 23 March 2020, the UK went into its first national lockdown. Lockdown laws placed varying levels of restrictions on movement, gatherings and business operations (House of Commons, 2022). The Coronavirus Act 2020 came into force on 25 March 2020, its aim was to protect public health, to increase capacity in the NHS for those who were seriously ill and to guide the public to take the right action to support safety of themselves and others. The announcement of a national lockdown impacted on all students’ education, particularly healthcare students. This was because the UK's health system was under immense pressure and this would undoubtedly affect students’ ability to learn and be supported (Health Education England [HEE], 2020a). However, those students who were already qualified adult nurses, in this instance students on a SPQDN, were employed by healthcare organisations and there was an expectation that they would be recalled to the workforce to support colleagues on the frontline (HEE, 2020b). To the authors’ knowledge there are no studies that have focused on the lived experience of student district nurses during this time, although there are articles considering how the situation affected pre-registration nurses (Hamadeh Kerbage et al, 2021; Michel et al, 2021; Curcio et al, 2022; Head et al, 2022; Jardon and Choi, 2022).
Methods
Research question
The study aimed to address the question: what was the experience of qualified adult nurses who were enrolled on an SPQDN qualification during the COVID-19 pandemic?
Aim
The aim of this study was to explore the feelings, thoughts and experiences of student district nurses during the first UK national lockdown resulting from the COVID-19 pandemic.
Design
An interpretative phenomenological qualitative approach was undertaken to explore the lived experience of the students undergoing the chosen phenomenon, to answer the research question (Bowling, 2014).
Recruitment
A convenience sample of eight registered nurses who were enrolled on an SPQDN course were recreuited. The gatekeeper of this study was the co-researcher (SS), who consented to students being emailed. The primary researcher (HM) emailed students in June 2020 with a participant information sheet and an opportunity to ask any questions. The email contained a link to join a virtual focus group and if the students wished to take part, they could use the link to join on a specified date. One participant asked whether a single interview was possible and this was accommodated. Participants completed an electronic consent form when they joined via the link and emailed it to the researcher ahead of the meeting.
Participants
The participants (n=8) were registered adult nurses working in the community setting who had been seconded from two local NHS trusts in the north west of England, to be enrolled onto the SPQDN course. While seconded, the students would usually hold supernumerary status for the duration of the course, which was 11 months in this case. All participants were woman. Ages ranged from 30–47 years of age. The students’ years of service as a registered nurse ranged from 3–14 years (mean 9.25 years). The years of service in the community ranged from 2.5–14 years (mean 6.8 years). They had started the SPQDN in September 2019 and completed in July 2020.
Data collection
The data were collected via a one-to-one interview and an online focus group (using Zoom) in July 2020, both of which were scheduled to last up to 1 hour. Zoom was used for the focus group because of restrictions on movement and meeting, which limited face-to-face contact in response to COVID-19. To put the time of this focus group into context, the national lockdown had been lifted with conditional measures on 10 May 2020, but local lockdown measures were in force. This meant areas could be locked down locally if there was a high number of COVID-19 cases. At that time, face masks were advised to be worn in crowded spaces and on public transport. Governmental advice encouraged employees to work at home where possible to minimise the spread of infection.
Ethical considerations
Before the study, ethical approval was obtained via the university ethics board (19/NAH/036). Informed, written consent was gained from all participants before the interview and focus group took place and they were advised they could leave or stop the interview at any point. The principal researcher was known to the participants because of previous contact at the start of the programme and this was acknowledged by incorporating reflexivity throughout the study to minimise bias. Reflexive practice involved the primary researcher keeping a journal of their thoughts and own lived experience of the first lockdown, throughout the study design and data collection, to reduce the likelihood of these thoughts being voiced to the participants (Braun and Clarke, 2022). A semi-structured agenda was used to reduce subjective questioning and common generic probes were used to draw out the participants’ feelings, as opposed to them being led to an answer by the researcher's questions. The fact that the principal researcher was known to participants seemed to be a benefit as they were comfortable to talk honestly about their experience as a student district nurse during the COVID-19 pandemic. The co-researcher did not take part in the data collection or data analysis because they were deemed to have a conflict of interest. However, the co-researcher did act as a peer reviewer in the planning and written dissemination of the study. It was anticipated that this may be a particularly emotive topic, so participants were advised that they could leave at any point. It was explained that once data had been transcribed they would be anonymous and non-identifiable so individuals’ data could not be withdrawn then.
Data analysis
The focus group and interview were recorded on Zoom with consent, for the purpose of transcription. A transcript was then available from these recordings, and the principal researcher transcribed the data to ensure accuracy. This was labour intensive but allowed full emersion into the data to confidently identify themes. The data were read multiple times by the principal researcher and was coded using the Braun and Clarke (2006) model of analysing data: (a) familiarisation with the data, (b) generating initial codes, (c) searching for themes, (d) reviewing themes, (e) defining and naming themes, and (f) producing the report. Three emerging themes were identified: anxiety and uncertainty, management of risk and teamwork.
Results
Anxiety and uncertainty
“It was like no one knew what our role was. I didn't even know what our role was anymore. They were like, are you on the SPQ, and I'm like, I don't know.”
A high level of uncertainty was raised by all participants, because it was not known if they would complete the course or become a student with supernumerary status again. All students in the study had student supernumerary status removed in March 2020 when they were recalled to the community nursing workforce. Communication was unclear about when this was to be reinstated. Participants reported feeling concerned about how they would manage things, such as going to work, homeschooling children and completing their academic work, while at times experiencing COVID-19-like symptoms themselves. Two participants noted they drank more alcohol during the pandemic.
“We wasn't a student because we had supernumerary status took off us, so we wasn't a student really. We was just back in the thick of it.”
The participants understood the need to be recalled back to the frontline and work in district nursing teams. However, poor communication around this decision and the implementation of it increased anxiety levels. Students did not know which team they would go to and for how long. Student were now frontline practitioners during unprecedented times. Three participants reported receiving a call the night before they were expected to be back on duty, one as late as 4pm. The lack of time to prepare emotionally for this caused anxiety and upset.
“I was just so anxious of the unknown of what to expect in the workplace.”
“I did cry, I was scared.”
One participant was very worried about hand hygiene and being able to wash their hands safely, to minimise the chance of taking the virus home.
“I'm thinking how? Where am I eating my dinner, how am I washing my hands, you know what am I going to bring home. That, for me, I was just having like a meltdown with that.”
There was also general concern about adequate personal protective equipment (PPE), as a result of media reports, but this was not the case among participants, who felt they had enough. One participant recalled taking their uniform off in the garage before entering their house, because of concern about transmitting COVID-19 to family members.
Two participants felt it was frightening to be a nurse working during the lockdown caused by the pandemic. They also noted that they felt privileged that patients and their families trusted them as nurses to come into their homes. However, it was also cited that some people did not want the district nurse to visit, because they feared the virus being transmitted to them. Gratitude had been shown by the public. A box of chocolates had been given and a participant recalled a nurse having had their petrol paid for at a garage. However, one participant noted that although they felt they had made a difference, by the point of data collection there was a sense that they as an individual no longer mattered. This was further supported by a participant recalling two nurses in her team being reported because they had worn their uniform into a supermarket before their shift began.
“…you actually felt quite privileged to be a nurse at that point. Obviously no one cares about you again. One time we just felt a little bit like we made a difference.”
One participant noted that study days missed because of being recalled to the workforce was given back to them by the trust that employed them. However, there was also acknowledgement that some students had practice hours to recoup. One participant felt frustrated by this lack of flexibility around the number of practice hours to be achieved; they were having to work back practice hours they had missed because of needing to isolate as per government guidance at the time. Consequently, this increased stress as the participant had to perform clinical work, as well as complete academic work when others had study time.
Management of risk
The management of risk was a recurring discussion point and included using family members to undertake patient care where possible, for example administering insulin and dressing non-complex wounds. Participants discussed having to postpone some care, such as vitamin B12 injections and routine preventative pressure area checks. They also discussed making contact before visiting homes to ensure nobody in the household was displaying COVID-19-like symptoms or had tested positive, because this affected what type of PPE was to be worn.
“The caseload cleansing that was done, there was a lot of patient contact then made prior to visiting patients to make sure there was nobody in the household displaying symptoms, the patients weren't, nobody had tested positive so we needed to know which PPE to wear and a lot of the visits were changed.”
As a result of the regularly changing guidelines around PPE and lack of consistent testing, staff did not feel confident that they knew what PPE to wear to be safe, so they would wear all PPE available to support personal safety. PPE and visiting care homes was discussed and participants reported feeling guilty that they had the appropriate equipment, but staff in care homes did not.
“I just felt like really, really bad, because what am I supposed to do? I mean, it's just unfair basically.”
One participant commented that care home staff looked petrified and they felt guilty for wearing full PPE for a 15-minute visit, when they were there all day with none.
“…my staff wear them, like a ghostbusters, go to the nursing home, whereas the other staff in a nursing home, their own staff, they wear nothing, they don't even have a basic mask.’
“I went into a nursing home and I had all the PPE, well we didn't know he wasn't confirmed at that point but it was afterwards and the staff were looking at me, as if to say why have you got PPE and we haven't.”
The increased use of digital technology helped to reduce risk of transmission, by reducing contact between people in the workplace. One participant felt remote working increased productivity because of a reduction in travelling time such as going to the office after morning calls and attendance at meetings. However, this was caveated with the fact that they felt this impacted on teamwork and increased staff isolation, because of the lack of team contact and communication.
“You're really isolated because you can't go into the office and maybe you had a really difficult death and you know you think, I can't even go into the office to go and get a hug off someone.”
This was compared to nurses working in the hospital, who did have peer support on a shift compared to a district nurse who was working remotely every day. One participant noted that the daily safety huddle was conducted remotely and that was an opportunity to see all the team, albeit virtually. One participant, who was shielding, noted that digital remote working allowed the organisation of meetings to be completed more quickly; the relevant experienced professionals could all meet sooner, without the barriers of booking a room and travelling. As a result of attending these meetings and completing root cause analysis reports, their strategic knowledge of services and patient care was enhanced. Furthermore, it also allowed them to remain working and stay safe while they were not able to conduct frontline nursing duties.
One participant discussed an ethical dilemma they experienced, regarding family members visiting their relative's address when they were at the end of their life. This was during a time when there were restrictions regarding the movement to different households. The participant advised that they escalated this to senior staff for advice and had been told that they could remind the family of the legislation, but ultimately it was their decision on how they chose to act. It was empathetically acknowledged that this was a person's father who was at the end of their life.
Teamwork
Peer support and teamwork was echoed throughout the data collection by all participants. The ability to talk to someone and be listened to, by someone who understood because they were in the same situation was cited as positive. One participant recalled talking to their team leader and the fact that they had just listened added to their own personal resilience. There was an element of the team providing student status where possible by trying to reduce the daily workload to allow for some developmental time, as it was acknowledged that the participant still had academic assessments outstanding.
“I just supported people emotionally talking to them, saying you're doing amazing, like don't knock yourself, you're doing the absolute best you can.”
The student district nurses also referred to a WhatsApp group, in which peers on the SPQDN course in the same situation could communicate and support each other. There was an appreciation that members of the district nursing team may be shielding and as such they might require psychological support, so this provided regular opportunities to chat to someone. A participant acknowledged the dilemma of being a nurse and having a duty of care to patients, alongside protecting their own health if they were vulnerable. There was understanding that the whole team needed to be supported. One of the participants recalled concern about a team member that was triggered by their inactivity on social media, which was unusual for them. The participant went to the staff member's house, found them extremely unwell and called an ambulance.
“We've got our little WhatsApp group and the girls do message, I think it's just speaking to people saying, oh God, this happened and that happened.”
There was positive team work locally in district nursing teams, but participants felt that management had not communicated with them about the SPQDN course and completion as well as they might have. For example, not returning students’ phone calls and contacting them at short notice with decisions. One participant felt they should have had a regular Zoom meeting with their peers to allow peer-to-peer discussion and regular updates from course leaders/management. However, communication had been haphazard and inconsistent.
“…all of a sudden, we just got a phone call. Yeah mine was about 4:00 o’clock just saying, you're going back tomorrow. Like literally going back in the morning. And, obviously I've got two young children as well, so I was a bit worried.”
“I was saying what's happening with our course and she said, you will finish it I just don't know when.”
There was an increase in the workload of district nursing teams, as some services closed, such as treatment rooms, and GP surgeries requested home visits. To support this increase in demand, clinical staff were redeployed to district nursing teams. An example was given of a practice nurse and a health visitor who were redeployed and how they felt anxious because of this new role, even though they were experienced clinicians. However, they had been supported on patient visits by another person at the start and they were only allocated calls they felt competent to do, to ensure patient safety. Positively, they also brought transferrable skills, such as knowledge of long-term conditions, management and previous district nursing experience. Concurrently, one of the student district nurse participants had been redeployed into a specialist IV team and into three different district nursing teams, which they verbally advised they thrived on. However, the prospect of moving to different teams worried other participants in this study. Two participants felt that they stepped up into leadership roles when the team leader was sick. They felt it was their duty to do this because they were on the SPQDN course, which was preparing them to be district nursing leaders of the future.
There was peer support noted with regards to doing joint visits. It was identified that because of a reduction in GP visits, community nurses had to verify deaths, an expansion of their role. Two participants had completed the verification of death training while they were a student district nurse and they went out together to verify their first death. It was noted that becoming more confident with this new skill, did have a positive impact, because they could reduce waiting times for families who needed this to be done and could also follow the patient journey to the end.
Discussion
To the authors’ knowledge, this is the only UK study which explores the experience of student district nurses during the first lockdown of the COVID-19 pandemic. The authors note there is international literature available, which focuses on the experience of pre-registration nurses and the stress and anxiety they felt (Hamadeh Kerbage et al, 2021; Michel et al, 2021; Curcio et al, 2022; Head et al, 2022; Jardon and Choi, 2022; Svavarsdottir et al, 2023). Yet the participants in this study are different, because they held student status, but were employed members of staff and registered adult nurses, and as such were recalled to the workforce. They understood the rationale for this, but the way this was undertaken and the lack of communication they experienced heightened their anxiety and worry. The findings from the present study primarily focus on the participants’ experiences of being a community nurse on the frontline during the start of the COVID-19 pandemic in the UK. Even though participants were enrolled onto a university course, their professional identity was foremost that of a nurse, who happened to have academic work to complete, as opposed to them feeling like students who could focus on studying for the SPQDN qualification. Literature shows that a majority of healthcare workers including nurses reporting a strain in their physical and mental wellbeing during the COVID-19 pandemic. This was exacerbated by wanting to deliver excellent person-centred care under difficult circumstances, while managing responsibilities outside of work, which this study concurs with (Holroyd et al, 2022; Veldhuizen et al, 2021; While and Clark, 2021; Davey et al, 2022).
It is noted that all participants in the present study were women. This is in keeping with nursing being a femaledominated profession in the UK, with 89 out of 100 nurses being women (NMC, 2022b). This population is known to have been disproportionately affected, compared to men, during the COVID-19 pandemic, as women made up a high percentage of nurses that provided direct contact to infected patients (Luceño-Moreno et al, 2022). An online survey of 444 female Spanish nurses in 2020, found anxiety and depression was a predictor to emotional exhaustion and burnout (Luceño-Moreno et al, 2022). Added weight was given to this conclusion when researchers collected data from 235 health professionals in July 2020 via an online survey that also found high levels of anxiety and burnout during this timeframe of the pandemic (Giusti et al, 2020). Concurrently, the female participants in the present study reported feeling anxious and scared regarding the prospect of being a community nurse working through a pandemic. They were also at risk of burnout from the outset. Additionally, the participants faced an additional facet of uncertainty around their role identity; they were also students and were unclear how they would progress on the course. The worry was exacerbated by poor communication, information displayed in the media and facing the unknown while working in a pandemic.
There was a feeling of guilt regarding PPE when visiting care homes. It has been recorded that nurses working in care homes felt isolated and government guidance regarding working across different care settings had a detrimental impact on staffing (Birt et al, 2023). This lack of PPE was believed to be because of issues with supply and demand, which resulted in supplies going to NHS trusts, hospices, and community care organisations before care homes (Daly, 2020). This had an impact on hospital discharges because care homes would not accept new residents because of the lack of masks, gloves, aprons and goggles (Butler, 2020). A bespoke supply route to care homes only became available on 15 May 2020, which was nearly 2 months after the lockdown began and the death toll was continually rising (Department of Health and Social Care, 2020). This lack of preparedness to care for society's older people could be attributed to poor planning or years of cuts and austerity (Daly, 2020).
During the pandemic, there was a vast increase in demand for palliative care in community settings, because of a substantial increase in mortality rates. During the first 10 weeks of the pandemic (7 March–15 May 2020), there were 41000 deaths related to COVID-19, which equated to deaths in care homes increasing by 220%. Home and hospital deaths increased from what would have been usually expected by 77% and 90% respectively (Bone et al, 2020). In 2021, researchers surveyed 559 respondents from primary care and 100 people noted that they cared for patients who deteriorated rapidly, particularly people who were already frail. Palliative care is a key role of any district nursing team. However, the rate and frequency of end-of-life care during the start of the pandemic was exponential. This, combined with a higher workload and staff shortages resulting from sickness and shielding, led to staff becoming emotionally and physically exhausted (Mitchell et al, 2021). Given these statistics, it is unsurprising that 58.2% of 387 community nurses advised their involvement in providing end-of-life care in the community had increased compared to the norm. It was acknowledged that a potential factor in why workload increased was because of people wanting to remain at home, as opposed to being admitted to hospital. It was cited that if people were to be admitted, this meant families could not visit and individuals did not want to die without their family being there (Mitchell et al, 2021). This issue posed an ethical dilemma in the present study, as participants were visiting houses where family members were attending, while legislation at the time restricted this. There was an empathetic response that people were visiting their parent at the end of life, and that family were able to make their own decisions with regards to the legislation and social distancing. Not having visited their loved ones at the end of their life will have undoubtedly had an impact on individuals’ grief and bereavement journeys (Torrens-Burton et al, 2022).
Mitchell et al (2021) found that the roles of the multidisciplinary team changed to meet the demand for increased end-of-life care. An example of this was that 41.2% of 559 respondents said they had been more involved in verification of death, specifically community nurses (P<0.0001) compared to GPs. This is supported by the findings of the present study, in which two participants said they had undertaken the verification of death training while on the SPQDN course and then performed this task for the first time during the pandemic. This supported workload and most importantly family members as they were able to respond in a timely manner. Being able to develop new skills and share knowledge to other team members and develop others’ competence regarding verification of death has been noted as a positive aspect of being a SPQDN supernumerary student previously (Marshall and Sprung, 2023). It is evident that participants in th present study had a very active role in caring for patients during the COVID-19 pandemic and that palliative care was an ingrained aspect for community nursing teams. However, coverage was predominantly from the hospital setting, which meant the contribution from community nursing was not suitably acknowledged (Bowers et al, 2020). This lack of recognition is further supported by the fact that initially only COVID-19 hospital deaths were recorded in national figures and in media reporting, and the high number of people dying in the community setting was not acknowledged (Reynolds, 2022).
Community health services had to change and adapt rapidly to respond to the risk of transmission, by reducing face-to-face contact in the workplace, so the use of digital technology increased, and all handovers and meetings were to take place online (While and Clark, 2021). Participants in this study discussed the benefits of this, yet it was clear that participants missed the peer support which face-to-face handovers gave them, especially after dealing with ‘a difficult death’. As Nyatanga (2019) wrote, it is important that teams discuss and reflect on the end-of-life care in a supportive environment to reduce anxieties, yet because of reduced footfall in offices, this was not possible. It has been suggested that this lack of contact contributed to staff stress (Nyatanga, 2019). Moreover, communication and feeling you can talk to someone and being listened to, was seen by paricipants in the present study as a key aspect of supporting personal resilience. Strong team relations and leadership is noted to have contributed to a positive impact on staff wellbeing (Davey et al, 2022). Peer support and team bonding was key to providing long-term psychological support for healthcare professionals, especially as they were witnessing high numbers of dying patients (Maben and Bridges, 2020; Mitchell et al, 2021). Yet, those working over large geographical areas or in community settings may have found this difficult, compared to those working in acute hospitals with other staff members.
Two participants verbalised they felt proud to be a nurse and that they felt they were making a difference. They felt appreciated by the public because of the offering of small gestures and gifts, as Veldhuizen et al (2021) also found. This notion of pride was supported by researchers who also found this when they conducted five focus groups with 22 nurses in the UK (Davey et al, 2022). They also felt rushed by their healthcare trusts to ‘get back to normal’, once the acute phase of the pandemic was over. Furthermore, some of the pastoral support offered to them was stopped too soon, because of the mindset that normality had returned (Davey et al, 2022). However, in the present study, this feeling of pride was caveated by one participant who said they now felt they did not matter again. The example cited was a complaint regarding wearing uniform in a shop. Carolan et al (2020) noted there had been a complacency regarding wearing uniform to and from shifts. But that this was exacerbated by a lack of staff changing rooms and laundry facilities, which is an issue in community settings. This raises the wider point that staff are not supported to adhere to infection control guidelines because of a lack of facilities provided to them.
Paticipants in the present study acknowledged that because of services closing, an additional workload was placed on district nursing teams. Mitchell et al (2021) found that 77% of 387 UK community nurses citied they were undertaking face-to-face visits ‘more or a lot more’, whereas 40% of 156 GPs said they were doing ‘less or a lot less’, which made nurses feel abandoned. This rise in visits would undoubtedly have had an impact on a service which was already struggling to cope with the gap between workforce capacity and demand (While and Clark, 2021). To support the workforce capacity and demand, staff were redeployed from other services to help. Yet, as Merchant (2021) noted, it may seem that workforce numbers were increased, yet this could also be restrictive as redeployed staff may have a specific skill mix and so appropriate delegation was needed. As Davey et al (2022) found, this had the potential to increase the workload of experienced community nurses resulting from the careful delegation of visits for redeployed staff, because of their unfamiliarity with the environment and patients. This meantcomplex visits were left to those who had the greater experience, which can increase the risk of stress and burnout for them (While and Clark, 2021). Furthermore, an online survey completed by 500 people, which was conducted by the RCN's district nursing forum, found district nursing teams continued to provide care when other services identified they were at full capacity (Green, 2021). Additionally, because of the workload demand, visits were regularly postponed. Only 1% of respondents left work on time and 70% did not take a daily lunch break (Green, 2021). This is in addition to increased personal demands on staff time, which was identified in the present study, such as continuing academic commitments because they were still student district nurses, and family requirements including home schooling.
Strengths and limitations
To the researcher's knowledge this is the only study which reviews the experience of student district nurses working during the COVID-19 pandemic. It is important to add this perspective to the literature base to complement those studies from a hospital and pre-registration student nurse viewpoint to provide a comprehensive view.
The primary researcher of this study has experienced the programme from a personal and professional standpoint, because they hold the SPQDN qualification and have taught sessions for previous cohorts. The primary researcher had also met this group at the start of their SPQDN journey, as part of a different research study. However, any level of bias was reduced with the use of a semi-structured focus group agenda and reflexivity throughout to ensure questions were not leading. As the participants had met the facilitator of the interview and focus group before, this would have contributed to a positive relationship allowing for an open and honest discussion of a sensitive topic.
All the participants were women. It would have been beneficial to have a variety of genders as part of this study. However, as nursing is a female dominated profession currently, this was outside of the researchers’ control.
It would have been beneficial to have explored the educational aspect of the participants journey, as well as their time as a frontline community nurse. However, participants clearly wanted to discuss this, and trying to cover both aspects in a one-hour data collection session would likely have reduced the quality of the data collected. Furthermore, at this point in the students’ journey on the SPQDN, most of the teaching had been delivered.
Conclusion
The findings of this study highlight the experience of qualified adult nurses who were also students. It is important to capture this information from this moment in time, to plan for future occasions when student district nurses are potentially recalled back to the workforce. It is clear that a lack of communication and uncertainty about their future on the DNSPQ course contributed to heighted stress and anxiety. Therefore, a planned and systematic approach would be beneficial if this level of national response was to occur again.
Teamwork and camaraderie are a vital aspect of any team and is an important aspect when supporting others in times of stress. Communication is a key aspect of teamwork and this can be continued remotely to ensure members of the team do not feel isolated. However, the lack of face to face contact that district nursing teams were able to have, did have a negative impact, especially there was a substantial increase in demand for palliative care.
This study has demonstrated the contribution that community nurses gave during the start of the COVID-19 pandemic and how they played an integral role in patient care. Much has been written on hospital care, yet it should be remembered that district nursing is the service that never reaches capacity and never shuts its doors. The themes identified in this study demonstrate the wider implications that trusts should acknowledge when strategically preparing for any aspect of disaster planning, such as a future pandemic. This would mean that future cohorts of students are recognised in that preparation, to ensure they feel supported, communicated with and valued in their work and study.