The New Zealand Nursing Experience in COVID-19
By Catherine Smith, Clinical Nurse Specialist Lung Cancer, Christchurch Hospital, New Zealand
2359 hours, 25 March 2020 New Zealand went into Lockdown Level 4 with the goal to eliminate COVID 19. All New Zealanders were instructed to stay at home (in their bubble) other than for essential personal movement. Health care services were reprioritised, and travel was severely limited. Visitors were not allowed in any rest homes or hospital level care facility.
Many lung cancer patients had already placed themselves in self-isolation before the Lockdown levels were announced. A GP or hospital visit was avoided as many patients thought these were the places of highest risk of contracting COVID-19. The respiratory high suspicion lung cancer clinic operated as usual, however, PPE was worn and only the patient was able to attend the consult. Oncology consults were changed to phone calls. Treatments were modified, chemotherapy was shortened to 4 cycles and maintenance, radiation fractionation was reduced. Surgery was suspended to prepare for the potential influx of COVID patients.
Patients were not allowed a support person present at any appointment during the 5 weeks of Level 4. This put the patient, family and clinical staff under huge distress. Frequent misunderstanding between the patient and clinician required clarifying conversations with both groups to ensure the right information was gained. Allaying fear and providing education and support was a huge component of our work.
Lockdown Level 3 (Restrict), didn’t reduce patients’ fears. Many would not attend for scans or visit health facilities. Frequently, we would have to contact the GP practice to enable a patient to be seen face to face. Patients continued to have frustrations with lack of community personal cares and District Nurse visits. Data from Christchurch Hospital ED presentations indicated that the number of patients with lung cancer symptoms, MI or CVA reduced during Lockdown Level 4 & 3. Some patients with COVID-19 symptoms were diagnosed with lung cancer.
Level 2 (Reduce), has brought increased social contact and a small increase in lung cancer patient numbers. We expect an influx of those patients who have not sought medical attention for their symptoms during Lockdown.
Telephone contact is a huge part of the Lung Cancer Nurse role in New Zealand. The lockdown period has emphasised how important this type of contact is with lung cancer patients. Most importantly, this experience has taught us the importance of having support people present with clear communication.