Dear diary: I am a community nurse caring for patients in a pandemic
Nurse’s shift diary reveals the challenges of delivering care in patients’ own homes during coronavirus lockdown
Monday March 23
Lockdown day 1: anger, confusion and fear
First day of lockdown. In line with trust policy, we are trying to cut down the number of physical visits to patients, so those where we offer emotional support and ensure patients are managing are now being done over the phone.
I am seeing patients as I normally do, not in uniform and carrying all my equipment in a backpack. I have been told I don’t need to use personal protective equipment (PPE).*
Where possible, and only after a risk assessment has been performed, patients’ relatives are being taught how to help with their care. I visit a patient for her weekly injection. Her son, who is on lockdown with her, is now administering her eyedrops and is confused and annoyed by this. I explain why a nurse visiting his mum four times a day could be putting her at risk and watch as he administers the drops, reassuring him he is doing it right.
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My next patient, Mr C, is refusing to stay in lockdown. He has multiple co-morbidities and if he contracts COVID-19 he could become seriously ill. But when I try and explain how serious the situation is, he swears at me and ignores my advice, which is frustrating.
My last visit of the morning is to Mr B, a housebound patient I know well. He has daily visits from one of our nurses and I always make the time to chat with him, even if it is only for five minutes. He has no family and I have been worried about him, so am relieved when he tells me he has had lots of offers of help from his neighbours.
Many of my patients are confused about COVID-19 and are asking lots of questions, such as what are the symptoms, how is it transmitted and how serious is it? Many don’t understand why our visits are being reduced.
When I get back to the office at lunchtime, I learn that my colleagues have had similar experiences, with patients seeming to know very little about COVID-19 and why we are now under lockdown.
One of my afternoon patients, Mr R, is bedbound and has severe dementia. He is cared for by his wife, and also has carers coming in four times a day. When I arrive, Mrs R is arguing with one of the carers, who says he doesn’t need to wash his hands because he has sanitising hand gel.
I explain that hand gel will not remove contaminants from his hands and that he should wash them. He isn’t very happy about it, but he does as I ask.
After the carers have left and Mr R’s clinical needs have been met, I talk to Mrs R who is worried about her husband. He was seriously ill last year with pneumonia and is vulnerable to infection, and Mrs R is worried that the carers are not following hand hygiene requirements. They are not bare below the elbows when performing personal care and often do not have any hand sanitiser as they say their agency does not provide it.
I promise Mrs R I will speak to social services, who manage the home care contracts, but I am frustrated at having to do this. I can’t ignore it but I have enough of my own work to do without having to police the carers too.
Tuesday March 24
So much for social distancing, and does anyone know where the PPE is kept?
My Tube into work is busy – not as busy as rush hour on a normal Tuesday, but far too busy to practise social distancing. I look at the other people in the carriage and wonder how essential their journey really is.
I visit Mr C again, who is still refusing to obey the rules of lockdown. Again, I try to explain the risks and again he just swears at me.
When I arrive to see Mr G, another bedbound patient we see daily, he asks why I’m not wearing a face mask. I tell him I’ve been told I don’t need one and he says he is worried about me contracting COVID-19. I’m touched by his concern.
Many of my patients are worrying about COVID-19, but some are also complaining they are no longer getting home visits from other health professionals, such as their GP or physiotherapist, who are only offering telephone consultations. I’m tempted to point out that we, the community nurses, are still visiting them, but I don’t.
I buy my lunch from the supermarket opposite our health centre. As I queue up to pay for it, a woman stands behind me. She is so close I can hear her breathing. When I remind her about social distancing, she looks at me as if I’ve sworn at her.
During the afternoon, we get a referral for a patient who has tested positive for COVID-19, who needs post-operative care. The big questions are about PPE – what do we need and what do we have?
Our trust has guidelines and an online video about putting on PPE, but it is all about inpatient care. We are told to wear a gown, filtered mask and face visor, none of which we have.
I call my partner, an infection control nurse, and he explains the community guidelines to my manager; that we only need gloves, aprons and masks, and face visors if the patient has an active cough. Problem is, we have no face masks or goggles in the health centre.
After a call to another team, we find there is a store of them for the district nursing service. It’s at a health centre five miles away from our office though, which is at least a 30-minute drive away. My manager says she’ll collect them tomorrow.
Wednesday March 25
A reality check
At home, after work
My partner comes home tonight looking really stressed. He tells me he’s had a horrible reality check on one of the hospital’s medical wards, which he frequently visits during the pandemic.
Three patients died on the ward from COVID-19 today and the ward manager was upset and stressed out. She showed my partner a large cupboard full of bags, containing the belongings of patients who had died. No one knows what to do with them. Would the relatives want them back? How would they decontaminate them?
My partner was confronted with a physical reminder of how many patients are dying. As nurses, we are seeing the reality of this infection and the loss of life. Each one of those bags contained the belongings of a person. They will no longer need them.
Friday March 27
I wake up with a cough, fever and backache. My partner tells me these are symptoms of COVID-19, so I call my GP surgery who tells me to call NHS 111. After being on hold for an hour-and-a-half, I finally speak to someone. I have a very quick triage and the call handler tells me a doctor or nurse will call me back shortly. Ten minutes later a doctor calls and tells me he thinks I have COVID-19 and to stay off work for at least seven days.
I feel awful. I am needed at work, but I cannot go in. I would be putting both my patients and colleagues at risk, but I still feel guilty. I’m a nurse with years of experience and many clinical skills, it doesn’t feel right sitting at home when my patients need me, but I have no choice.
*This advice was given before the government issued new guidance on PPE for healthcare staff.
The author is a community nurse in London