UK - Long Covid guide for community nurses

[John Mac]

Updated long Covid resource launched for community nurses

The Queen’s Nursing Institute (QNI) has published an updated resource for community nurses caring for patients with long Covid.

The updated resource has replaced a previous version that was commissioned by NHS England and NHS Improvement and published by the QNI in December 2020, when long Covid was emerging as a serious consequence of the pandemic, but was still poorly understood.

The updated QNI resource highlighted that long Covid is best considered as a multi-systemic condition and that nurses will need access to a multi-disciplinary team to ensure patients with the condition are getting the right support.

Dr Alison Twycross, nurse academic and founder of the group Long Covid Nurses and Midwives UK, welcomed the new guidance, and particularly its inclusion of children and young people and how it highlighted the role of nurses in assessing those with the condition and signposting them.

However, she was “disappointed” that the aspect of long Covid the resource focused on "first" was mental health.

“While this may not have been intentional, it feeds into the perception among some parts of the health service that long Covid is primarily psychosomatic rather than mental health issues being caused by having an illness that severely impacts everyday life,” said Dr Twycross, who has had long Covid since 2020.

She stressed that guidance documents should also focus more so on addressing underlying causes of symptoms, rather than just on wellbeing and learning to live with it.

The updated QNI resource, titled Living with Long Covid A Community and Primary Care Nursing Resource was launched at the QNI’s annual conference in October.

https://www.nursingtimes.net/news/c...rce-launched-for-community-nurses-07-11-2022/

 

[Trish]

Hmm. I've had a look through it.

It seems mostly to be a list of references of where to refer people for specialist help and guides by other organisations like OT and physio, while at the same time claiming community nurses are best placed to care for pwLC.
Given that there's a huge shortage of community nurses in the UK and they are already fully occupied, I can't imagine they will be taking on the care of most pwLC, except possibly those discharged from hospital and those with other conditions who are already on their client list. pwME aren't referred to community nurses for our care.

It's good to see some mention of staying within anaerobic threshold, but too much reliance on uevidenced things like mindfulness.

 

[rvallee]

It seems mostly to be a list of references of where to refer people for specialist help and guides by other organisations like OT and physio, while at the same time claiming community nurses are best placed to care for pwLC.

Given that there's a huge shortage of community nurses in the UK and they are already fully occupied, I can't imagine they will be taking on the care of most pwLC, except possibly those discharged from hospital and those with other conditions who are already on their client list. pwME aren't referred to community nurses for our care.

That makes zero economic sense. Or any sense at all, since they would make no difference. What would the nurses even do? Be around? For what? I don't understand how people can be willing to do useless things when they already can't keep up with all the useful things that are needed. This is Being There medicine, just be there, that's it. Maybe 1/100 of the time. Why? For what purpose?

 

[Trish]

I think there is plenty nurses can do particularly regular home visits for pwME who are housebound to ensure medical and care needs are being met. In our submission to the NICE consultation we made what seemed to me a good case for the person overseeing care to be a specialist nurse rather than a therapist.

 

[BrightCandle]

I think there is plenty nurses can do particularly regular home visits for pwME who are housebound to ensure medical and care needs are being met. In our submission to the NICE consultation we made what seemed to me a good case for the person overseeing care to be a specialist nurse rather than a therapist.

All the studies say they are not would telling it directly to a nurse even matter? Unless someone turns up capable of medically doing something, who understands the disease and fundamentally can prescribe drugs its a useless energy expenditure. People with ME/CFS that are housebound or worse benbound need social support carers to deal with life necessities and then they need specialist doctors to visit and adjust medication for symptom relief and regular check ups on basic health. I don't see the value of a nurse visit at all.

 

[rvallee]

I think there is plenty nurses can do particularly regular home visits for pwME who are housebound to ensure medical and care needs are being met. In our submission to the NICE consultation we made what seemed to me a good case for the person overseeing care to be a specialist nurse rather than a therapist.

For severe patients, sure. They should also be followed by a GP, though. Otherwise it makes little sense. But the needs of severe patients are much more than nurses can do unless they are assigned 1:1 full time, which makes no sense and won't happen. It does nothing for the vast majority of patients, nursing is a specific skill that doesn't translate well for the most part here.

The economics don't work at all. It's trying to stretch a single loaf of bread for an entire village. A plan based on this premise is not viable.

It would be far more effective to end the state of systemic discrimination so that most patients are not ostracized from their family and friends and can get this basic help at home. This is the kind of help that family usually provides, not because it's ideal but because of simple economics. Discrimination removes this unpaid care for the most part, it doesn't make sense to pay twice over (or more) instead.

 

[Trish]

I think we’re talking about different aspects of care.

In the UK chronic diseases such as Parkinsons Disease, MS and severe asthma have specialist doctors who do the diagnosis and prescribing, but patients only have relatively rare access to them, and need someone with specialist knowledge working under the consultant who can monitor symptoms, signs and treatments and visit at home if necessary, and be much more accessible for patients to contact. This role is filled by specialist nurses. They can recommend and sometimes prescribe changes to medication carry out regular assessments and also ensure that if the person needs care at home such as feeding, washing etc, social services are brought in to assess and provide for personal care needs. They can also arrange referrals for OT, dietician and physio input as needed. And they can provide emotional support.

My point about this role of specialist nurse as the intermediary between consultant and GP and patient is that nurses seem to me to be better qualified for this than OT's, physios or psychological therapists.

 

[Trish]

Just to clarify, this guide has been produced by a charity called the Queens Nursing Institute whose role is to support community nurses. The main organisation for nurses in the UK is the Royal College of Nursing.

The article linked in the opening post is in the Nursing Times and is critical of the guide.

Quote from the Nursing Times article:
“While this may not have been intentional, it feeds into the perception among some parts of the health service that long Covid is primarily psychosomatic rather than mental health issues being caused by having an illness that severely impacts everyday life,” said Dr Twycross, who has had long Covid since 2020. She stressed that guidance documents should also focus more so on addressing underlying causes of symptoms, rather than just on wellbeing and learning to live with it.