Warning: Invalid argument supplied for foreach() in /home/nclexion/public_html/wp-content/themes/jnews/class/ContentTag.php on line 47
The global Covid-19 pandemic is likely to have a lasting impact on health service workloads and service design for some time to come. Increasing numbers of people are experiencing ongoing effects of the infection, as outlined in the NIHR Centre for Engagement and Dissemination’s review Living with Covid19 just released.
There is now an emerging picture of people of all ages with prolonged periods of debilitating ill health. One-stop Covid-19 diagnostic clinics are needed to ensure that clinical treatments are offered where available as is specialist support for those people with long-term organ damage. Many people are self-managing an uncertain and unpredictable disease in their own homes with existing health and social care services unable to meet their needs.
People living with Covid-19 need to continuously monitor their health status, particularly as new symptoms emerge. They need to be able to discuss when to seek further medical consultations, as well as help to develop personal coping strategies and to be supported in the decisions they make about their health. They may need help with activities of daily living and also need advocates to navigate health and social care systems. In short, their needs reflect Virginia Henderson’s 1964 definition of nursing:
“The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge.”
The multisystem and non-linear nature of ongoing Covid-19 symptoms requires a skilled generalist who can provide clinical support and case management as part of a community-based multidisciplinary team (including nurses, psychologists, physiotherapists and occupational therapists).
This has echoes of the community matron programme, introduced in England in 2004 within The NHS Improvement Plan. While the role was directed at those with long-term conditions and aimed at reducing hospital admissions, the work has parallels with the needs of people living with ongoing Covid-19 in that it provided holistic support, across different medical specialities and social care. Community matrons were intended to anticipate, coordinate and join up care.
Chapman et al (2009) reported that community matrons adopted a systematic approach to educating patients to facilitate self-management. Community matrons also provided a single point of access for patients and a link between primary and secondary care. General practitioners considered that their workloads had been reduced by the community matrons assessing patients and taking decisions that might otherwise have resulted in GP contact. GPs thought that this led to better use of their time and improved patient care.
Early evaluations showed a disappointingly low impact on hospital admissions, although Bentley (2014) asserts that the high value placed quantitative evidence of case management neglected and failed to acknowledge the patient experience. As a result of this partial evaluation, the role has largely been superseded by other initiatives for admission avoidance. Maybe, the emergence of Covid-19 means it is time to revisit community matrons and the role of skilled nursing generalists.
Dr Elaine Maxwell is content lead, Centre for Engagement and Dissemination, National Institute for Health Research
Bentley A (2014) Case management and long-term conditions: the evolution of community matrons. British Journal of Community Nursing; 19: 7, 340-345.
Chapman NL et al (2009) Community matrons: primary care professionals’ views and experiences. Journal of Advanced Nursing; 65: 8, 1617–1625.