Pandemic in Primary Care 
Talk Tuesday - June 9, 2020



We'll discuss how the role of a primary care nurse has shifted and adapted during COVID-19. The presenters will share their successes, challenges, and stories and discuss what they have done personally and as a team to cope and thrive during these unprecedented times.

Presenters

Laura is a nurse practitioner with roots in primary care. She worked for five years as an RN and loved the possibilities that came with the role. She has worked mainly as a primary care nurse as well as a chronic disease nurse in English and French positions. She is thankful for the opportunity to be the president of the Manitoba Primary Care Nurses Association to advance excellence and education for the vital practice of primary care!

Kim has been nursing for over 30 years, and most of that work has been in primary care settings. She has also worked in acute care, public health, and addictions care.  Each type of care is crucial, and they all are integrated and interdependent, but primary care is such an opportunity for health promotion, the prevention of health problems and catching problems early.  Kim works at Klinic Community Health Centre and appreciates their commitment to inclusive and holistic care.

Josée has been a nurse for two years in both the NICU and now primary care. With a passion for health promotion and Indigenous health, Josée will be returning to complete a masters degree in Community Health Sciences from the Rady Faculty of Health Science at the University of Manitoba with a goal of working in research and health policy.

Session Summary

Joining us this evening were three Primary Care Nurses - Laura Donnelly, a nurse practitioner working at Centre de Sante, Kim Froese, a community health nurse working at Klinic Community Health and Josée Lavallee a primary care nurse working at Centre de Sante. 

They each spoke about their successes and challenges as COVID-19 first came into the awareness of care providers in Manitoba, through March and April as information and protocols were updated more than once per day and now as people are more willing to seek care and some restrictions are easing a bit. 

How healthcare was delivered in Manitoba changed dramatically when the first case of COVID-19 was discovered in mid-March. Traffic to the walk-in clinic decreased significantly though they still saw patients in person. Some regular primary care visits were cancelled or rescheduled, and some went ahead by phone. Staff and patients were screened before being allowed to enter the building, and if able, patients were asked to wait until immediately before their appointment to enter the building. Screening, cleaning, PPE and testing guidelines changed sometimes more than once a day. That constant change on the background of uncertainty was hard for providers to cope with and hard for patients and their families to cope with.

That constant generalized background of uncertainty seemed to make patients more open to discussing mood and mental health, and that became an important part of each visit, in person or by phone, no matter the original intent of the appointment. Also included, was education about how to keep themselves safe and healthy ways to cope.

Each presenter shared how their teams continue to support one another through this time: some are purposeful about checking in on others and making sure staff take turns screening & testing COVID-19 suspect patients, others organized time capsules with staff experiences or silly song contests like a French ode to O Canada but about COVID-19 and many allow more grace and leniency for their colleagues acknowledging that this is a new experience for everyone. 

Question and Answer

Please click on the questions below to expand them to see the answers.

1. Can you speak to the impact the RHPA has had on primary care?

a. not specific to COVID-19, Laura shared that she was aware of a potential change to how team clinics would operate and suggested consulting the CRNM or Association of Primary Care Nurses of Manitoba for more information.

 
2. Can you talk a bit more about mechanisms for coping with anxiety?
a. Josee shared that acknowledging anxiety was a normal reaction seemed one of the most helpful things with her patients, strategies include explicitly acknowledging that in conversation and increasing frequency of phone calls (some clients receive weekly check in calls).
b. Melanie shared that with her clients she tends to focus on strategies like progressive muscle relaxation, controlled breathing and mindfulness practice. 

3. Can you talk about testing and tracking?
a. COVID-19 test results are available in eChart
b. Patients can now look up their own results online in the screening tool
c. Public health connects directly to patients who have a positive COVID-19 result  and does all the tracking

4. How do you help your patients cope with anxiety when they have to go to the hospital for something surgery or imaging?
a. Josee described encouraging patients to protect themselves by following public health advice and talking through the risk vs benefits of going to a healthcare facility using the example of INR monitoring - a person may have go to weekly which may present a very small risk of transmission, but having an unknown INR level is a significant health concern. She acknowledged that the choice always belongs to the patient. 

5. What are the most important things you’ve learned in the past few weeks?
a. Laura shared that she is impressed with the creativity of people still finding ways to connect and share experiences even distantly, and how meaningful it is to know that everyone you see is aware of the same thing that you are aware of. 

6. Is there a plan to increase accessibility to well child visits, other in person programs and vaccination programs?
a. For these staff at Klinic and Centre de Sante these visits never stopped. Some of the vaccinations were re-booked for a month later in mid-March when things were very new and uncertain, but those have all been re-booked, and everything else has carried on differently, but done. 

7. Can you speak to access to care for bariatric patients?
a. Some delay - a wound care clinic moved into the bariatric facility at Centre de Sante to allow for isolation rooms for COVID-19 suspect & positive individuals.

8. How has your client teaching changed with the pandemic?
a. In the beginning, the end of every visit or call tended to end with some COVID-19 safety tips. Now that the numbers in Manitoba have remained low, it’s more a reminder to continue with those same strategies. There has been much more willingness to listen to suggestions for healthy coping strategies too.