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Sister Valerie Topping, Ward 8 Manager (COVID19 Ward), South West Acute Hospital – Reflection of COVID19

Valerie Topping

There are few common features, for the staff of Ward 8, Acute COVID Ward, at the South West Acute Hospital, in comparing our experience of caring for patients during the first surge of the pandemic, last March/April, to the current time.

The planning for the first surge was, in many ways, ‘reactionary’. Everyone, the world over, was living the experience of this new virus for the first time and seeing how it affected people. Medical staff in Northern Ireland were learning from the experience of other European countries, which were a few weeks ahead of us, in their experience.

In preparation for the first surge, all the nursing staff on my ward, the medical team and domestic staff responded willingly to the challenge ahead, casting aside their own, understandable, anxieties -mainly for their own family members. It was difficult for us to watch the media coverage of Italy and Spain and to understand that we would soon be working in those conditions; it felt surreal. We  planned for our response, we discussed new ways of working, refreshed our practice of “donning” and “doffing” (putting on and removing), the PPE. Staff received training on managing patients’ symptoms of COVID19, particularly in the “last days of life”. We  worked  closely with the Respiratory Medical staff, ordered in large quantities of respiratory equipment to support these sick patients; we all contributed to evolving new ways of working, which would also support keeping  staff safe, so they would be there to look after these sick  patients.

Months on and the ‘second surge’ has rolled into the ‘third surge’, for the people of Tyrone and Fermanagh and for the staff at the South West Acute Hospital, too. Last Spring, we transferred from being the ‘acute respiratory specialist ward’, into a ward accepting patients who were confirmed COVID19 positive. Our first experience of caring for COVID patients predominantly lasted about five weeks, during which time we never reached our full occupancy of 18 patients. Nonetheless, it was a difficult time for all staff; we didn’t know what the outcome would be for our patients; we had little to compare to.

This recent surge has seen in-patient numbers reach almost 50 in our hospital, with two additional wards now caring for COVID patients; each of these additional wards acting as a ‘step down’ ward. It is a very different experience for us all. Having transferred back to a medical ward over the summer months, Ward 8 again transitioned into an Acute COVID Ward last October; we are now over four months caring solely for COVID patients. It is undoubtedly very demanding on staff, both physically and mentally. We wear a full level of PPE when with patients; this makes working conditions difficult, wearing PPE for prolonged periods, which is both uncomfortable and tiring; it makes it difficult to talk to patients and to be heard. Caring for these patients can be overwhelming, with staff developing close relationships with many patients, who often share their fears and anxieties with the nurses, physiotherapist and medical staff. Both nursing and medical staff keep families informed of how their relative is progressing and we often arrange ‘face time’ calls between the patient and a family member, who may be isolating themselves, to talk to those patients too unwell to make a phone call, or who haven’t access to a smart phone. These calls can be very emotional. More recently, the Department of Health issued guidance to facilitate a ‘managed’ visit of a family member, within certain circumstances; it too can be emotional, yet rewarding, for us to play a part in organising this visit.

Patients admitted are obviously sick and there is always a fear and awareness that they can deteriorate at any time, or quite rapidly, hence their condition is monitored frequently. At critical times, nurses and doctors are often ‘willing’ patients to breathe, watching their every breathe and monitoring their oxygen and blood gas measurements, hoping their condition will respond to the oxygen therapy and their positioning and avoiding a further escalation of their management. Patients can experience several complications of having COVID, a common complication being a clot on the lung. Many patients require oxygen to support them and for some, this is delivered via positive pressure ventilatory systems on the ward. For some patients, it can take them weeks to wean off the oxygen, whilst their lungs gradually recover from COVID and its effects. We now have an improved knowledge of how to best manage patients with COVID19 and some of the early research trials have proven better outcomes for both survival of patients, or lessening the complications and effects on the lungs, of the virus.

For myself as a ward sister, to observe the members of my nursing team, some of whom were only qualified six months at the time of the first surge, take on the responsibilities of caring for COVID patients and the implications of this, for both their own practice – working in very different circumstances and the implications for their families, makes me feel both humble and proud. During the first surge, some staff moved out of their family home or had other members of their family move out, for fear for their relatives’ health. Staff and their families unselfishly compromised themselves. Many staff have again responded to the peak in admissions, by working additional hours on a regular basis, committed to both supporting safe patient care and supporting their colleagues. We are fortunate to work alongside some amazing individuals within the Respiratory Medical Team, who demonstrate care and compassion for their patients, also working additional hours each day or covering on-call rotas more frequently.  As a nursing team, I am assured that we are giving our patients the best standard of care possible.

From the early days, the respect and support all members of the team have provided for each other is exceptional. Everyone watches out for the welfare of each other – both physically and mentally, whether they are medical, nursing, domestic or Allied Health Professional (AHP) staff; we all support the welfare of each other within the wider team. We work closely with all members of the healthcare team, to support the patients through the acute period of their illness, through their anxieties and promote their recovery. We also work closely with the Palliative Care Team, who review and advise on the management of those patients who are reaching their final days.

We have lost a significant number of patients this time and there is no downturn in these numbers to date. It can be difficult for staff, observing patients deteriorate and supporting their needs and the family members. It is made more difficult because we are working in such unusual circumstances, talking ‘remotely’ with relatives and not getting to know them in the usual way and they are deprived of daily visits to see their loved ones. Despite the government restrictions that we have lived with, at varying levels, since early October, hospital admissions have steadily increased. This is a very different experience to the first surge, when admissions peaked at a far smaller number and were short-lived. On numerous occasions in recent months, we have cared for several members of the same family and we have also experienced families losing more than one relative to COVID.

Therefore, it is vital every individual considers their own responsibility in fighting this virus and we all need to comply with whatever is asked of us, to minimise the spread. None of us should be complacent and think we won’t contract it or pass it on; many people can display no symptoms, yet test positive. We all need to ensure we maintain social distancing, wearing a face mask, washing our hands and minimising our movements whenever we can, avoiding gatherings of people and minimising our contacts, in keeping with current government guidance.

The added consequence of the current high level of COVID is the standing down of some other health care services for a second time; something which HSC Trusts have tried to avoid. Whilst hospital admissions remain high, then inevitably those on waiting lists will continue to wait and some cancer services will be delayed, which can have an untold consequence on individuals. None of us would wish that for our family members. It is vital that we reduce transmission within our communities.

Looking forward, I hope everyone gives serious thought to taking the vaccine, when it is offered to them. Unlike the seasonal flu vaccine, which ‘at risk’ people  take to keep themselves well, the COVID vaccine is not just about protecting yourself, it is about protecting everyone; even people we may never meet. My worry is that if insufficient numbers of the population agree to take it, then we will be left living with significant consequences of COVID19 over at least the next 2-3 years. Hospitals will continue to be burdened with COVID related admissions, families will continue to experience bereavements and we will all experience further restrictions in our every day lives.

As the slogan says, “We all need to do it, to get through it”.

Thank you