Nursing in Practice Winter 2021 (issue 122 | Page 26

26 ANALYSIS
Dealing with long Covid
Common long Covid symptoms
In the absence of sufficient long Covid clinics , patients are often seen in general practice or the community . Walesbased ANP Helen Lewis says a growing number of patients are presenting with long Covid symptoms ; in the space of a month , the number rose from around two patients a week to an average of six . She says district nursing teams will be ‘ inundated ’ with long Covid patients , and stresses that the condition will also be having an impact on extended families , with patients unable to care properly for elderly relatives or look after children .
However , Ms Lewis says she expects nurses to become more comfortable about dealing with long Covid as they see more patients with the condition . It will become ‘ second nature ’ to order blood tests to rule out conditions with similar symptoms , such as thyroid or rheumatic problems , she adds . Ms Aston has referred patients to long Covid clinics but says ‘ it ’ s a long-winded process ’, while the referral form itself is confusing , and includes a checklist of long Covid symptoms that could also indicate postviral fatigue .
Extreme tiredness Shortness of breath Chest pain or tightness Problems with memory and concentration
( so-called brain fog ) Difficulty sleeping Heart palpitations Dizziness Pins and needles Joint pain Depression and anxiety Tinnitus , earache Feeling sick , diarrhoea , stomach ache , loss of appetite High temperature , cough , headache , sore throat , changes to sense of smell or taste Rashes
Source : NHS : Long-term effects of coronavirus ( long COVID ). 8
Take patients ’ concerns seriously
Identifying long Covid can be challenging . Despite the often confusing presentations of the condition , the key consideration for nurses should always be to take patients ’ concerns seriously . ‘ The first thing people in the long Covid advocacy group say is that they want somebody to believe them ,’ says Dr Maxwell .
Ms Aston says it is important nurses ‘ really listen to patients and allow them to talk about what they perceive as possible long Covid symptoms . We need to value their experience and hear their concerns ’.
Sufficient time also needs to be allocated for patients to receive ‘ a thorough assessment from highly skilled professionals ’, says Eve Thrupp , a Queen ’ s Nursing Institute manager of nursing programmes for leadership who is involved with the QNI ’ s Long Covid Expert Nurses Group . ‘ Community nurses are ideally placed to carry out these assessments , as patients are often known to them so they have an educated insight into their individual needs ,’ she says .
As well as using their knowledge and skills to refer patients to long Covid clinics , Ms Thrupp says nurses should consider alternative care pathways , guided by the patient ’ s preferences , such as identifying different kinds of pain medication .
What ’ s being missed ?
Resources
Online
The long Covid knowledge gap means that ‘ unfortunately in the public mind , and therefore in the minds of some non-specialist nurses and doctors , long Covid is a respiratory illness ’, says Dr Maxwell .
She warns community nurses may be putting patients ’ symptoms down to other chronic conditions . ‘ Because of a lack of understanding about long Covid , it can be easier to attribute symptoms to something else ,’ she says .
Ms Thrupp says an awareness of all the differential symptoms is ‘ critical ’ but adds that there is a sense that some of the physiological aspects of Covid are recognised less often than the psychological aspects .
‘ Nurses who attend the Long Covid Expert Nurses Group are acutely aware that this could be happening . It has been recognised within the group that some individuals , such as those with a learning disability , children and young people , have long Covid symptoms that may not be recognised as such ,’ she says .
Some individuals may have long Covid without ever having had a Covid-19 diagnosis . Rhona Aikman , a practice nurse based in west Scotland , says that , out of a caseload of 8,000 people , she has so far seen just 10 patients with symptoms of long Covid . But she suggests long Covid might be ‘ a bigger problem ’ for her patient population , because some individuals who have never had a positive Covid test are still presenting with long Covid symptoms .
E-learning . Free access via HEE . bit . ly / 3xcqbsB
QNI resources : Living with Covid-19 . bit . ly / 3c3a078
Coronavirus Information Centre . bit . ly / 31TzamT
Your COVID Recovery . bit . ly / 3oC1emD
Pulse : Implementing the long Covid enhanced service . bit . ly / 3F3ATEs
Long Covid Kids charity . longcovidkids . org
Living With Covid Recovery . bit . ly / 3kJzEm4
Full Covid-19 coverage nursinginpractice . com
High-quality education
With the potential for missed diagnoses , the current scale of long Covid and its prevalence in the longer term could be even greater than thought . Nurses ’ support will be vital to the wellbeing of this growing patient group but Dr Maxwell says the profession as a whole has so far been ‘ quite slow to respond ’, and ‘ nobody has taken long Covid by the scruff of the neck ’.
She says initial assumptions that the impact of long Covid would be limited have not been borne out , and that ‘ a rethink ’ about how to offer support is now needed . One way would be to take advantage of the model used to manage long-term conditions . Dr Maxwell told Nursing in Practice : ‘ I implore the chief nursing officer for England to look seriously at the role of nurses in a long-term conditions , long Covid model .’
She adds that she would like to see all the information available about long-term conditions ‘ put in one place ’ for practitioners to access , and for this resource to be funded by NHS England .
ALAMY / UNP
nursinginpractice . com Winter 2021