COVID-19 pandemic: A community health nursing perspective

Talk Tuesday - May 19, 2020



Watch on YouTube: https://youtu.be/HxseTSBwcI0

Presenters

Mhairi Lintott RN HBScN
Public Health Nurse, Access Winnipeg West

Mhairi Lintott has been nursing for the past 34 years in various provinces, with the last 19 as a Public Health nurse in Winnipeg. She graduated with an honours baccalaureate degree in science from Lakehead University. From there Mhairi has worked in rural Saskatchewan, Northern Manitoba, North Western Ontario, and Nunavut, all of which have been tremendous experiences and has shaped the nurse she is today. Mhairi has enjoyed the challenge of working, most recently, on the centralized Covid-19 team with the WRHA.


Sylvia Camara Tavares RN BN PNC (c), Public Health Nurse, COVID-19 Public Health Team

Sylvia Camara Tavares is a Public Health Nurse with over 20+ years of experience in the Public Health domain and is currently working on the COVID-19 Public Health Team.  She graduated with a Baccalaureate in Nursing from the University of Manitoba and began her nursing career at St Boniface Hospital on a high-risk postpartum unit. Sylvia transitioned to Public Health in 2005. During this time, she received her Douglas College Certificate and became a Certified Lactation Consultant.

Sylvia also worked as a SANE (sexual assault nurse examiner) with Health Sciences Centre and worked in Home Care privately with Medox. Sylvia received her Perinatal Nursing Certificate with the Canadian Association of Nurses and completed her Winnipeg Regional Health Authority / Red River College certification in Health Services Leadership & Management in 2016. A self-professed people-person, Sylvia is passionate about community health, and more importantly, how she can make her community a better place.

Tanya Horton, RN BN, Communicable Disease Coordinator CD & Immunization Program

Tanya Horton has worked in varied Public Health Nursing areas for more than 20 years, with a passion for communicable diseases throughout.  The first half of her career was spent in British Columbia, followed by a return to Manitoba with nearly a decade supporting Winnipeg's Inkster community.

Her most recent achievement is as  a Communicable Disease Control Coordinator within the Winnipeg Region which she has held for just over a year.  Her role provides regional and Population and Public Health program leadership in immunization and the prevention and management of communicable diseases and outbreaks within the Winnipeg Health Region.

Summary

Three community-based nurses shared their time with us to outline their regular work and how that’s changed and aligned to the effort to contain COVID-19.

Their usual work includes crucial building blocks of population and public health like healthy children and youth, healthy sexuality and harm reduction, immunization, Indigenous health promotion and communicable disease prevention and management. 

The World Health Organization outlines five strategic actions to contain a pandemic, the third is “Intensify rapid containment operations” and this is where these nurses in the community have been directing much of their effort. Their rapid collection of information to minimize transmission and spread can’t be emphasized enough. The COVID-19 team of nurses in community quickly grew from 6 to 12 public health nurses plus additional communicable disease coordinators, travel health nurses, administration and casual staff. 

The case investigation interviews these nurses perform are lengthy. They must assess the client, provide education about isolation, monitoring and recovery and then complete the contact tracing. The expectation is that they will have spoken with each of the contacts within 24 hours of receiving the initial positive COVID-19 result. This has been as quick as no contacts and as drawn out as 30 contacts for them to connect with. 

As this workload mounted the Provincial Call Centre was created and some of the screening work was diverted allowing the public health nurses to concentrate on active daily monitoring, case investigations and other core public health work. 

That core work has changed too. All of the groups they facilitate (Healthy Baby, breastfeeding & nutrition etc.) have stopped as have school-based immunization programs. They have modified other programs including postpartum follow ups by phone, dropping off scales and providing guidance by phone so families can monitor infant weights. If they do need to enter a home, they do as much of their work as is possible by phone to minimize time inside the home and wear personal protective equipment at every visit. 

 

Question and answer

1. What PPE is worn during home visits?

At minimum we wear a face shield and mask. If needed based on the screening we also wear a gown and gloves.

2. How does the management of public health differ between regions in the province?

Minimally. The guidelines and forms are provincial so the practice is quite similar though some regions may organize themselves a bit differently.

3. Is the screening done by Public Health the same as that done by Health Links?

Yes, the screening guidelines are provincial.

4. Do you have opinions regarding current criticism of the World Health Organization’s management and information provisions globally?

Not formally. We have heard the criticism, but this is the first pandemic of this scale in our career. It's our expectation that everybody has been doing their absolute best with what they had.

5. Do you have enough PPE? How do you store it and dispose of it?

Yes, we do. There's actually the potential to use less PPE since we are not doing as many home visits as usual. We take PPE and garbage bags in our cars and then dispose of the used PPE when we return to the office.

6. Are we using antibody tests to designate people as recovered?

No, not formally, though there is a study through University of Manitoba right now that is collecting samples.

7. Are you concerned about asymptomatic carriers?

Yes. This is why contact tracing is so important and also why the recommendations to maintain physical distance, practice excellent hand hygiene and respiratory etiquette can’t be relaxed even by those feeling well.

8. How do you see a vaccine rollout?

Right now, there's no formal plan that we're aware of. We expect it would likely roll out similar to how the H1N1 vaccine did with large clinics throughout the province and community clinics in urban centres.

9. When immunizations are being given - is there any concern about anaphylaxis and the need to provide CPR? Are there any special precautions that would need to be in place?

Absolutely. There are anaphylaxis emergency kits in all the immunization centres and everyone knows how to use them. They’re rarely used but it’s always a concern. There are Shared Health guidelines for resuscitation and those would be followed.

10. Are you aware if Shared Health has any planning in place for follow up of future anticipated rise in other communicable diseases that aren’t being followed up on because of COVID-19?

We’re aware of a firm plan at this time but this is being talked about.