Covid-19 reflections

22 July 2020

A community nursery nurse in England who retired and returned during the pandemic, and a health visitor in Scotland, reveal their recent experiences.

What is being missed?

I’ve worked as a nursery nurse in the health service for 38 years, with a couple of breaks. For the last quarter of a century I have worked in community nursery nursing, health visiting and more recently school nursing too.

Six months ago I decided to take my pension, have a month’s break and come back on far fewer hours. Little could I have imagined how much things would change.

Every day I saw WhatsApp messages showing how fast the pace of change was in the NHS. The past 10 years had been very stressful and this was my refresh and regroup period. I knew I could face it all... when I went back.

Six months on and how has my way of practising changed? It’s completely different. I’m doing behaviour visits and other contacts with parents and carers over the phone. I’ve always understood that only 7% of communication comes from the words we use. The rest is made up from intonation, body language and other non-verbal cues – that’s harder now.

Perhaps the biggest challenge for me is that the child’s voice is lost. You are only conversing with a parent/carer. Over the years, I have really developed the skill of understanding what children are trying to tell me, even when they cannot yet speak. Even non-verbal children are communicating all the time.

When I do visit homes, in PPE, children look at me strangely. My face and facial expressions are usually how I connect with children – my compassion and ability to empathise with them are detected – but that temporary, secondary attachment that enables the building of a safe and trusted clinical relationship is now hampered. So other skills get more use. I’ve done lots of Zoom or Microsoft Team meetings. It’s maybe a bit more efficient in terms of getting business done and not travelling so much, but the networking, the soft supervision, the camaraderie are lost or diluted. I always knew this was important as a practitioner who went agile a while ago, but this has taken it to a whole new level.

I worry about clients and patients – the new parents who are really, really doing this on their own. No respite, perhaps money worries, not getting the maternity or paternity leave they imagined. I worry about the isolation, the impact on mental health – and thus potentially the child’s mental health if their parents are stressed. I worry about the reduction in breastfeeding rates without any support.

What is being missed with developmental reviews? Will we have children with speech and language problems, as happened under targeted reviews in the 1990s? Will illnesses and ailments go under-detected because people are afraid to visit their GPs, even as services start to slowly become available?

Of course, the most serious concern is domestic violence and safeguarding. Yes, families are still being contacted but they may know to mention Covid symptoms, thus avoiding a contact face to face. This isn’t just health – social care is doing the same. These children may not be in school or nursery, so no one is seeing them. What are we storing up for the future?  

But I’d like to finish on a positive note. Teamwork has improved – everyone is looking out for each other far more than they did before. I don’t have to think about what to wear. The kitchen is a bit tidier (people are doing their washing up). I still go into work because it’s easier for me, but as it’s quieter I get more done. Anecdotally, I’ve also had behaviour reviews where families have said their children’s behaviour has improved dramatically since lockdown. Families are doing more things together and not rushing around all over the place, too, making many babies calmer as they’re not being taken hither and thither.

A new normal in Scotland

I switch on my work phone to read emails over breakfast. I open my laptop at the dining table for our daily team video call. Colleagues join from bedrooms, living rooms and kitchens. Our plan for the day is punctuated by complaints about sitting on sofas and the difficulty of working on a small laptop.

I telephone parents before visits to explain that I’ll be wearing PPE, and to ask whether they are experiencing any coronavirus symptoms. Once at their door, I put the apron, mask and gloves on. Most of my visits require use of a phone for interpreting, but the touchscreen doesn’t recognise gloves.

While the health visiting service attempts to continue as normal, local community groups and services have closed their doors and moved to telephone appointments, yet many do not provide interpreting services. Over the past 10 weeks I’ve contacted emergency dentists, registered children at school, walked to pharmacies to collect prescriptions, and arranged various appointments on behalf of families.

Recently, a man approached me having recognised me from the health centre. As I introduced myself through a face mask, he handed me a card with the contact details for a palliative care clinic. He explained that he had been unable to reach the clinic on the telephone. So I used the browser on my phone to find an alternative number, only leaving once he had found the person he wished to speak to.

I carry out some of our assessments over telephone in an attempt to reduce the time I spend in homes. I’ve spent 45 minutes on the phone planning a short 10- to 15-minute visit to weigh and measure a baby. Five minutes into the home visit, I realise mum hasn’t spoken to anyone since I saw her two weeks ago; I leave 40 minutes later.

I listen to parents grieving for the experiences they had planned and the denied visits by friends, how they’re unable to place a new grandchild in their grandparent’s arms. Some describe the balancing act of supporting a partner, caring for children and attempting to work from home.

Many parents have seen changes to their employment. For those furloughed, the new government software can handle 450,000 applications an hour, processing their claim in six days. For others, food donations and a five-week wait for Universal Credit is the new normal.

On the drive home, I pass billboards thanking the NHS and I wonder whether I’m bringing Covid-19 back with me, and if the desk and computer screen I’ve spent hundreds of pounds on has arrived. Visits are taking longer now, so I arrive back later than I planned. My clothes are placed in the washing machine and I jump in the shower, which adds another 30 minutes to my working day. When I return to the living room to write up my notes, I open my laptop to messages about missed clinic and immunisation appointments. 

Picture Credit | Shutterstock

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