A year on: still looking in
This blog is written by Rachel Campbell. Rachel is an Inflammatory Bowel Disease Advanced Clinical Nurse working in a district general hospital that serves a population of around 480,000 on the outskirts of Manchester. She wrote a blog in April 2020, at the height of the pandemic about her experiences working with her regular patients, and here she reflects on the surreal year since then.
Well what a year it has been… with new words filling our vocabulary that weren’t so used before like ‘lockdown’, ‘roadmap’ and ‘maskne’ to name but a few. The summer of 2020 came and went with glorious weather and Covid restrictions. Autumn saw a new lockdown and people’s tolerances wavering as the weather turned cooler. Looking back to the first lockdown, that time seems a blur now as we didn’t really have time to fully process the enormity of the pandemic because we were so caught up in it. From a working point of view, it has always been ‘business as usual’ throughout the last year, but with new ways of working to deal with the situation.
Changes at work
At the hospital, the telephone review became the ‘norm’ but was not ideal – I still prefer face to face. We did provide the option of video consultations, but even this is not the same as reading body language and being able to pick up on what people are not saying. Our helpline was the busiest I’ve ever known it. We had triple the amount of calls coming in and not the full team to answer them due to a temporary reduction for three months. My mental health training has been put to the test over the last year with a considerable increase in my lovely IBDers (Inflammatory bowel disease patients) not necessarily having problems with their bowels, but with the mental health effects of the pandemic. It has meant my phone has been very active with patients not managing and with me doing some home visits for my more complex lovelies. The increase and demand for patient reviews also drove change in the form of me developing a new service.
In the late summer of 2020 we started our HOTIBD clinic – born out of the need to review, assess, investigate and treat patients with ongoing inflammatory bowel disease symptoms that would otherwise have attended their GP, rung the helpline or presented to A&E. The clinic started in the late summer of 2020 after the initial surge of Covid saw a rapid increase of flaring patients. There were increasing numbers of patients attending A&E with flare ups of their conditions, but not necessarily receiving the right treatment at the time (we must soon develop a robust assessment/treatment pathway). This clinic has been a welcome service improvement which will stay going forward as it has proved its worth in supporting patients – ensuring patients were seen when they needed to be. The challenge has been though that other services stopped or were greatly reduced, including endoscopy services.
Changes at home
On a more personal note, having 17-year-old twins doing college at home and abiding the lockdown rules presented challenges in itself. In order to create spaces to learn, I lost my dining room to one and the other hasn’t been out of her bedroom since last March. I dread to think what I might find in there but it might explain where our missing crockery is… The fact I still went out to work from 7am until 6pm every weekday but came home to a sink full of pots and monosyllabic teens meant I cherished my weekends. I developed a love of an urban ramble, clocking up some walking miles around my home area and having the neighbours able to set their clocks by me going past their windows on a Saturday morning.
Balancing the hard work in the week with some ‘me time’ at weekends was valuable in keeping my own mental health in check. I have kept up my ramblings at weekends but now go further afield, with a routine pampering on a Sunday too.
What the future holds
Looking into the future, there are things that are staying including the HOT clinic, telephone or video calls instead of face-to-face meetings and my weekly personal rambles (although now I can venture further afield!)
We have had to adapt, but we needed to. We needed to progress and sometimes a diverse situation is required to force changes for the better. There will be people who are resistant to change, maybe through fear. But in the NHS, especially during the last year, we could not have operated how we had been doing, we needed to protect and support patients as best we could.
One of the proposed changes going forward is patient initiated follow up (PIFU) whereby stable patients can request a follow up if needed rather than be on a waiting list for a clinic and not necessarily accessing a clinic when they need it. I am keen to explore this as our waiting lists for patients to be seen routinely are quite long. Having stable patients, like our IBDers who are in remission, being able to initiate a review when they feel it’s needed gives them some ownership of their conditions and frees up some of the routine slots for new referrals and more complex patients.
So watch this space.
Follow Rachel on Twitter @ibdnurse
Photo provided by Rachel Campbell