Respiratory-trained nurses, with their specialist skill set have been particularly valuable from the start of the coronavirus pandemic in managing acutely unwell patients, up-skilling colleagues as well as maintaining routine clinical work.
This has involved providing expert support and advice to patients with chronic respiratory diseases. Many of these patients are in the extremely clinically vulnerable category and their mental health has deteriorated because of fear of catching the virus and due to months of isolation due to shielding. We are also seeing more patients with long Covid, with and without pre-existing chronic respiratory disease.
The current demand for services is incredibly high but also because some routine clinical work has been delayed. As much work as possible is undertaken via video consult, that isn’t always without some glitches, but where necessary patients are invited for face-to-face consultations. Integrated schemes such as virtual wards are also playing an important role, and these projects have reduced both the time spent in hospital and admission avoidance in those with less severe Covid-19, allowing safer monitoring in the community setting. The nursing workforce is supporting the implementation of COVID Oximetry @home programme led by NHS England through the provision of pulse oximeters and monitoring.
In the secondary care setting, respiratory-trained nurses have been integral in the provision of enhanced non-invasive ventilatory respiratory support for patients admitted with acute hypoxemic respiratory failure associated with severe Covid-19 pneumonitis.
The Get It Right First Time report advocated local multiprofessional care guidelines to ensure the appropriate management of patients with Covid-19 requiring oxygen therapy and ventilatory support outside critical care. Although decision-making around ceilings of care and escalation protocols are vital, the subject remains emotive, often testing resilience at every level. This is where joint critical care, respiratory and palliative care multidisciplinary teams prove invaluable, again with nurses at the heart of this.
Nurses, as well as their colleagues, have been incredibly adaptable to the changes in working environments, but at what cost? A recent study conducted during the first wave of the pandemic found that nurses working with respiratory patients experienced significant levels of anxiety and depression.
Many said they felt “overwhelmed” and “exhausted” juggling work and family life. They were also concerned about their own health, contracting the virus while working with high-risk patients and then bringing it home to their families.
"We have all found different ways to cope with increased worry and stress"
The NHS has recognised the increased pressure all staff in the NHS are under. A number of services have been developed as a result and informal support networks at work and at home are also proving valuable.
We have all found different ways to cope with increased worry and stress. Support from friends, colleagues and the public have proved invaluable during this period. A number of resources are available online including some useful tips on how to manage levels of stress with the work from the charity MIND, specifically developed for nurses and the more generic Health Education England short animated films on ways to support your mental health and wellbeing.
They suggest take some time before your working day to prepare yourself mentally by challenging any negative thoughts. If you enjoy mindfulness or breathing exercises this would also be a good time to do them.
During your working day it is also really important to take your breaks. Remember it isn’t a luxury, it is there for your safety as well as your patients. Check in with yourself and your colleagues during your workday by asking them how things are going.
Looking after your body at work by making sure you are eating some nutritious food and keeping hydrated is also important. Try to keep a work-life balance and do things you enjoy and that relax you at home. If you can, try and leave work at work, this is difficult if you have had a challenging day but what might help you, is to think of three things that went well and not so well and then reflect on them.
Respiratory nurses and health professionals working with respiratory patients are invited to join the Association of Respiratory Nurse Specialists (ARNS), an organisation run by nurses to influence respiratory policy at all levels, to encourage networking, education, research and evidence-based practice.
Maria Parsonage is respiratory consultant nurse and pleural disease specialist, Wirral University Hospital NHS Trust; Emma Ray is respiratory nurse specialist Sovereign Care Network, Fareham.