Hogeschool van Amsterdam

Urban Vitality

Community care: more vital than ever in the time of corona

But how?

6 May 2020 19:14 | Urban Vitality

'Keep using community care services!' The appeal made by Minister De Jonge of Health, Welfare and Sport on 14 April was quite clear, but to what extent is it actually being taken to heart in practice? How are community nurses providing care in these trying times? And can work placements still go ahead? Community nurse Lisa Hernaamt and fourth-year Nursing student Pressilia Lachmipersad share their experiences.

'Since the pandemic started, I've only seen a handful of my colleagues in the flesh,' says Lisa Hernaamt. As a community nurse, she and her team provide care to 85 clients in the impoverished Bijlmermeer area. In practical terms, the care they provide ranges from wound care to psychological help. Lisa's primary task is to draw up care plans, although she does get to visit clients regularly as well.

Since the start of the coronavirus crisis, there have only ever been three people at the office at the same time, which means that she has had to miss more than just a daily chat over coffee with her colleagues. Lisa: 'At work it's just easier to have a quick chat to catch up. I do miss that. At first we all worked from home, but our students in particular found it difficult to find the focus they needed there. I personally also preferred coming back to the office, as I don't live in this neighbourhood.'

SHARED CONCERNS

The weekly team meeting now takes place through digital means, as do the meetings with other community teams with which they formed a collective last year – the EG Buurt (Bijlmermeer) and DFH Vensterpolder (Bijlmer Centrum). Lisa: 'We're getting a lot of use out of Microsoft Teams and it has been working surprisingly well. It has been nice to be able to reach out to each other in this way, as our jobs are solitary enough as it is. Of course, besides the day-to-day business, we also share our concerns during those calls, because there are definitely concerns. For example, it’s impossible for us to maintain 1.5 metres of distance at all times. How can you provide care to a patient on home dialysis from 1.5 metres away? The same goes for a diabetic who needs his daily shot of insulin. And all that while we don't wear masks as a preventive measure, in accordance with the RIVM guidelines. Every day I’m grateful that we have not yet had anyone contract the virus yet.'

CORONAVIRUS EMERGENCY PLAN

If they suspect that someone poses a health risk, the protocol is to call in the special unit called the COVID team. That is all well and good, but it is far from ideal, Lisa says: 'These clients would suddenly be visited by someone they didn't know who was dressed like some sort of alien. It can really give them a fright, especially the vulnerable elderly patients, but we have to work with what we're given.' The COVID team was launched at the same time as their own emergency plan, because what do you do when part of the team becomes incapacitated? What care, medical or otherwise, would take priority? In determining this, they also took into account which care could be transferred temporarily to relatives or other informal care providers, and which care could be put on hold safely if necessary.

Although the extra pairs of hands provided by work placement students suddenly seemed more necessary than ever, all work placements for first and second-year students were aborted. Lisa: 'These students lacked the independence to be sent out to patients by themselves, meaning we couldn’t guarantee the quality and safety of the care that they would provide. Even in desperate times, we can't afford to let that slip.'

DIY WORK PLACEMENTS

Fourth-year Nursing student Pressilia had the good fortune that her work placement started in September 2019, which meant that she knew her way around in DFH Vensterpolder by the time the pandemic came around. It is not all about the timing, though. Pressilia: 'Independence is very important to me. The faster I can manage to internalise things and make them my own, the better. I also enjoy dealing with complex issues. That's why I was certain that I wanted a work placement in the home care sector. Unlike in a hospital environment, not all disciplines and tools are at hand here – and that requires creative thinking.' Creative thinking is appreciated more than ever during this pandemic, as is taking initiative. That does require some bravery (and occasionally a good helping of persuasiveness), but it gives you a wonderful rush, says Pressilia: 'We had a patient with diabetes, of whom everyone was certain that she would never be willing to administer her own injections. However, I managed to talk her into it with just one phone call. When I told my colleagues about it, they were all in shock – myself included!'

TAKING RESPONSIBILITY

Pressilia has successfully completed her work placement since, and she says that she is by no means the last one. The next batch of work placement students will also be able to complete a fully-fledged work placement – which she knows is something that many students fear they will miss out on. Pressilia: 'At meetings for the interprofessional academic work placement – which is part of the Wijk-Up Call! project* that has health care professionals and students of various health care programmes work together to help elderly patients in Amsterdam Zuidoost live at home – I’m often asked for the best ways for them to achieve their learning objectives. My answer to that is always "Dare to take a leap and put yourself out there!". Post a message on the ONS system, the employee portal, and don't be afraid to make a phone call when necessary.' Lisa nods, though she does have one caveat: 'We also have to do our part to make sure that the more elaborate intake and evaluation interviews don't get glossed over – which does sometimes happen in these trying times. At the same time, we have to look for alternative solutions to our problems, such as finding a way to sit in on an intake interview remotely.'

JOINING FORCES

'The only thing I really feel bad about is that I haven't been able to say goodbye to any of my clients in person,’ Pressilia reminisces. 'The personal connections that you build are part of what makes this job so special.' Even so, she is very satisfied with her work placement, and maybe part of that is actually because of the coronavirus. The pandemic meant that she had to work very closely not just with her colleagues, but also with the families and other informal care provides that were so ready and willing to help. Lisa agrees with that sentiment: 'These are strange, uncertain times in which nobody really knows what is going to happen. Even the RIVM guidelines are constantly changing and adapting. However, despite all the unease that brings, we're all joining forces to pick up the slack, and that has been wonderful to witness. We're really all in this together, and it matters now more than ever, as the need for our care services is slowly increasing again. So really, it's time that we all start looking to the future.'

*The Wijk-Up Call! project. A research project as part of which health care professionals and students of various health care programmes work together to help elderly patients in Amsterdam Zuidoost live at home.