10 June 2020
In the latest in our series of blogs exploring how the lives of our members have changed during the COVID-19 pandemic, we hear from Angela Jacklin, a Rheumatology Occupational Therapist and Louise Parker, a Lead Nurse for Rheumatology and Connective Tissue Disease.
Angela Jacklin is a Rheumatology Occupational Therapist at the Victoria Infirmary in Cheshire. She’s been splitting her time between rheumatology and ward work during the COVID-19 pandemic.
“Straight away we needed to think about how we could still provide a rheumatology service, so we’re primarily giving consultations over the telephone. It has its pros and cons but we’re able to gather information over the phone for an initial assessment and give advice on interventions such as joint protection, exercises, pain and fatigue management. We back that up with information sent to the patient either by post or by email. Patients then receive a telephone review to see how they’re getting on.
“For any patients that have a problem that needs to be seen face-to-face, like splints, we’ve got a post-COVID waiting list of people who we’ll see when restrictions are lifted sufficiently. However, if a patient needs a splint making or repaired urgently, we can see them in the department, following triage for COVID-19 and using PPE at their appointment.
“I can still order equipment for patients, such as toilet aids and perching stools, and they can collect it from the retailer or get a family member to collect it for them. The transition to telephone hasn’t been too problematic. Most people are very understanding, in fact some people haven’t even wanted to take a call because they’ve wanted to save NHS resources. So, we’ve had to explain to people that they’re still important and we’re still able to support them, just in a different way.
“Some of our patients are quite isolated at home, so they’ve been quite thankful to have someone ring them and see how they’re doing and give them advice on how they can manage their symptoms. There’s been a lot of raised anxiety amongst patients, so we’ve been able to give advice on stress management and signpost to mindfulness apps and websites. We have a relaxation CD that we send out that was produced by some of our rheumatology OTs, which is useful for patients having problems sleeping. My therapy assistant has also been ringing people up and doing relaxation with them over the phone.
“We’re now able to do video consultations if we need to. It’s in the early stages so we’ll are working on that, but it gives another forum for patients to connect with us and allows us to see things like ranges of movement and demonstrate exercises.
“To prepare for when restrictions start being lifted and people start coming back to the department, we’re making changes to accommodate that and work out our ‘new normal’. We’re looking at creating a one-way system around the department, socially distanced waiting areas and changing the phrasing in our letters to ask people to not bring multiple family members with them. We’ve got masks, aprons, gloves and visors in our department too.
“I used to run a fibromyalgia group, so my colleague Dr Yeliz Prior has developed an online version so we can now offer patients use of this website where they can take part in the programme. We’re looking at all the ways we can use digital tools for us to deliver our services.
“I’ve been working one day a week on the wards supporting inpatients who may be COVID-positive or who may be waiting for a negative screen so they can be discharged into a rehabilitation facility. This involves mobilising or practising essential transfers such as in and out of bed and helping them practise other daily living skills, such as getting dressed. For those heading home, I facilitate this by ordering any equipment they might need and making sure that the transition to home is as smooth as it can be.
“Recently I displayed COVID symptoms myself, but thankfully the test came back negative and I was able to go back to work again. I just want to keep supporting our patients through this challenging time.”
Louise Parker is the Lead Nurse for Rheumatology and Connective Tissue Disease at the Royal Free London NHS Foundation Trust. She has been balancing keeping rheumatology services running alongside shifts in ICU.
“At the beginning of April, as one of the senior nurses, I was asked to help plan how our teams could best support the crisis. I had some upskilling training in April so that I could be redeployed onto ICU to support colleagues there. I learnt about the pumps and machines, how patients should be positioned, how the observation charts work and how to document everything, plus a refresh on mouth and eye care.
“I split my role between two days a week in rheumatology doing telephone clinics and then two or three shifts a week in ICU. You’re not working alone; you’re working with a qualified ICU nurse to support them. Because of the numbers of people in ICU, the ICU nurses couldn’t work one-to-one with a patient like they usually would, so it was one-to-two or even on a couple of occasions, one-to-three. So, they’d have two people like me without an ICU background to support them do things like change fluids, draw up drugs and do the observations.
“It was a fascinating experience and the team were extremely supportive as well as grateful that we were there to help. The difficulty for me was going from one to role to another within a day. I was working in the rheumatology service Monday and Tuesday and the next day I’d be in ICU. It was quite challenging to switch between the two.
“Although ICU is big, there is a lot of equipment, pumps, ventilators, and cables everywhere, so it was quite cramped, claustrophobic and hot. Whilst wearing PPE you can’t have a drink, which is something I usually take for granted. I haven’t worked on a ward since 2005 and it’s been a very humbling experience; it’s extraordinary what the ICU nurses do. I usually spend a lot of time talking to my patients and of course in ICU they can’t talk to you, so a very different experience for me.
“I’ve now been stood down from my ICU work, with a view to going back should there be a second wave. I’m now turning my attention fully back to my rheumatology work. During the pandemic we’ve been continuing with telephone work and emails from patients, GPs and other colleagues. It’s still been busy, just in a different way.
“Patients have taken to telephone consultations fairly well. They don’t want to come into hospital anyway at the moment. They still get to touch base with us but in a less formal way. The majority of our patients know us well and are very grateful that we are still in touch and they are still being cared for.
“The pace of change has been phenomenal. We’re about to introduce virtual clinics and we’ll be working very differently for the foreseeable future. I don’t think we’ll go back to outpatient activity anytime soon.
“I think we’ll have to rely a bit more on community input going forward for managing our patients. That may mean they have to take on some of the more routine work and it may mean that we do some clinics in the community from time to time or a nurse-led community clinic – that could happen over time as well. In the next year or so, the pathways of patient management will change dramatically.”
Thank you to Angela and Louise for sharing their experiences during the pandemic. A free wellbeing support helpline is available for NHS staff from 7am-11pm seven days a week: call 0300 131 7000 for confidential listening from trained professionals and specialist advice, including coaching, bereavement care, mental health and financial support.