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COVID-19: a lasting impact on District and Community Nursing Teams?

Julie Green 9 Apr 2020 District Nursing Forum

The current coronavirus pandemic and COVID-19 are having a profound impact on the delivery of nursing care in every environment, not least care in the home.

District and Community Nurses report day to day challenges that include a lack of Personal Protective Equipment (PPE), inconsistent national guidance and negative comments to nurses by patients, relatives and members of the public. Despite this, there are many positives; enhanced, supportive team working, the deployment of colleagues to support community teams, the effective and successful promotion of self-management, the delivery of care and medication by family members and the integration of new technologies. 

When the pandemic has abated, we need to ensure that nursing in the community capitalises on these positives.

The current pandemic is having an impact that we could never have previously imagined. The population, apart from key workers, is socially distancing, there are nightly reports of tragedy, alarming mortality rates and devastating reports of the loss of colleagues from all disciplines of healthcare. It is truly shocking.

Rightly, critical care has received the major focus of media attention, with ventilators being rapidly sourced and the new Nightingale Hospitals being speedily developed. The often forgotten care that is delivered in the community by the full range of team members - Team Leaders, District Nurses, Community Matrons, Specialist Nurses, Community Staff Nurses, Health Care Support Workers and Administrative Support Staff - in 'wards without walls', seems to miss the spotlight, however, it remains essential, at the very heart of care provision for those patients at home. District and Community Nursing Teams provide complex person centred care; it frees up hospital beds, providing care for the burgeoning 'housebound' population alongside end of life care, complex dressings and support for patients with a range of complex conditions. Caseloads are expanding exponentially; rapid hospital discharges, often with uncertainty about coronavirus status, the withdrawal of routine face to face care by other services and closure of ambulatory care have added to these caseload commitments.

A recent survey of RCN District and Community Nursing Forum members to explore the impact of COVID-19 has revealed confusion and inconsistency with national guidance in relation to PPE, a lack of available PPE but also inadequacies with what has been recommended. Community staff have reported being heckled and abused on occasions by patients, relatives and the general public, labelled as 'disease spreaders' for travelling in uniform between visits. But what choice do they have? The use of family cars to travel between visits has never been so challenging; the transportation of clinical waste, returning home in uniform, training on donning and doffing are all processes complicated by the varied and often inadequate community environment in which care is delivered. The non-clinical home setting is presenting many threats to personal safety for the healthcare workforce.

Despite this, there are many positives as a result of the changes in the way we are working. Technology has come to the fore, with online team meetings and virtual huddles supporting care delivery, team working and staff morale. 'Critically cleansed' caseloads, with only essential care delivered, has led to increased self care and enhanced support for patients from their extended families. Patients are choosing to decline visits, preferring to avoid the potential threat that nurses may pose to them, and, as a result, are self managing their conditions like never before. This, if nothing else, needs to be something we take from this crisis; caseload cleansing and person centred care for appropriate patients should be the District and Community Nursing Team mantra as we eventually return to normality.

We are often an unseen workforce; COVID-19 may well have raised the profile of the essential care delivered behind closed doors. Let us use this opportunity to learn from the challenges and to capitalise on the positives.

District and Community Nursing Forum COVID-19 Survey Results 

Julie Green

Julie Green

Forum Chair

Dean of Education

A Professor of District Nursing and a Nurse Educator who is engaged in preparing the pre- and post-registration nursing workforce. A proud District Nurse who aims to raise the profile of District and Community Nursing at every opportunity.

Page last updated - 13/05/2021