COVID-19 has left no healthcare sector untouched in NSW. It is a subject that is widely discussed about how we have adjusted, reacted to and prepared for this unprecedented health crisis. We spoke to a few of our frontline health services members to hear in their owns words how they have coped with and adjusted to the impact of a pandemic in their workplace. In the interest of patient privacy and workplace protocol, our contributors will remain anonymous.
B is a Community Palliative Care Nurse who works primarily in South-West Sydney.
How has COVID changed the way you work/provide care?
Covid has meant that there are more patients at home who otherwise would be in hospital or palliative care units.
We have had patients taken out of residential aged care facilities because their families could not visit them.
Patients are generally worried on top of their usual worries.
Trying more than ever to keep people at home. Being in an LGA of concern means that patients and their relatives have to have a swab before every face-to-face appointment at hospital AND if they are coming in to a PCU.
What has been the most challenging impact of COVID personally and professionally?
Concern about catching COVID but more concerned about unwittingly giving COVID to a patient or their family at home.
Worrying about providing care to patients with COVID at home and if I will use the PPE correctly.
COVID seems to have affected every single aspect of the care we provide. Other services are not visiting but we still are.
What advice do you have for supporting patients and carers during these challenging times?
Be prepared. Read up all your procedures. Have your PPE at the ready. I was a close contact of a positive patient and I wore full PPE because I knew the family would prefer that. He had a terrible cough in his small poorly ventilated bedroom. No one suspected COVID but he tested positive when I sent him to PCU. Poor man died alone in a COVID ward.
Can you think of lessons we have learned during COVID that will benefit how we provide palliative care in the future?
We certainly have learned how to use telehealth and have found that it can be quite effective in some cases.
I am overwhelmed by the resilience of families who have learnt to facilitate telehealth and provide care at home rather than in hospital. They have been so patient with all the PPE and questions about being in contact with anyone with COVID, every single time.
Is there anything else you would like to share about your experiences?
We are even more short of staff since COVID due to staff attrition to other areas. Some staff have left nursing because of COVID and vaccination requirements. I wish I could retire myself.
C is a Palliative Care Nurse serving the CALD community.
How has COVID changed the way you work/provide care?
- COVID has increased the number of virtual and phone consultations.
- In CALD patients, it means an extra layer of challenge when a CALD patient is unable to navigate the English virtual app.
- It increased the use of interpreters on phone for the COVID safe questionnaire prior to each home visit.
What has been the most challenging impact of COVID personally and professionally?
- Zero direct skin contact due to full PPE on each home visit.
- It was challenging to ask family members and friends who don’t usually live in the same household to withhold or cancel their visit on the same day or leave the room when health professionals arrived.
- Option of work from home has reduced face to face time with colleagues and reduced informal debrief time.
- Delayed support from volunteers in CALD charity groups due to restrictions for visits and gatherings.
What advice do you have for supporting patients and carers during these challenging times?
- There’s help in the hospital and community for them.
- Don’t delay hospital admission. It will only prolong length of stay.
- For CALD patients -utilise interpreter services for each health consultation so that they can describe their symptoms and concerns in detail and properly understand our advise.
- Don’t wait till it is too late when visiting from overseas. A number of patients died when their family members were in quarantine. Conditions can change from stable to terminal for people living at the end of their life within two weeks.
- Seek and accept emotional support.
Can you think of lessons we have learned during COVID that will benefit how we provide palliative care in the future?
- Virtual care has it benefits. It is working well for multiple family members to be involve in a teleconference with the multidisciplinary team at the same time. This improves communication and reduces duplication.
R is a Clinical Nurse Consultant/Palliative Care, working in rural and remote areas.
How has COVID changed the way you work/provide care?
We have had to move more towards a telehealth model of care and generally only see patients face to face if they are in the unstable or terminal phase.
What has been the most challenging impact of COVID personally and professionally? Professionally, the most challenging impact has been establishing relationships with patients and carers when you can’t meet them face to face and making and maintaining that connection over time. I think it’s often hard to gauge what is happening for patients in the community when you can’t be in their space and see how they are coping. The need to quickly skill up on the use of telehealth technology at the beginning of the pandemic was a challenge and I know some of our older patients really struggle with the technology and feel disconnected from the staff when we can’t be in the same room.
Personally, the most challenging thing has been being separated from family, this is what “fills my cup” so to speak and I have not seen some of them for nearly 2 years now because of border closures. Seeing patients and families not being able to be together, not able to attend funerals and witnessing the obvious distress this causes as well as sometimes bearing the brunt of their frustrations and grief is hard. Particularly when they don’t understand that we are not the ones making the rules.
Can you think of lessons we have learned during COVID that will benefit how we provide palliative care in the future?
I think really learning how to use technology to the best of our advantage particularly in rural and remote settings.
What advice do you have for supporting patients and carers during these challenging times?
Be kind, be compassionate, we are all tired frustrated and sick of COVID. Nobody was truly prepared for this, and we are learning as we go.
We thank our contributors for their time and for expressing their personal experiences in the line of duty. If you would like to share your own experiences, we would love to publish them. Please contact us at info@palliativecarensw.org.au