Article by Louise Beitverda, Lead Respiratory Nurse
Prior to the COVID-19 pandemic, my role as the Lead Respiratory Nurse at UCLH involved leading a team of clinical and research nurses. The research work included inputting information into the national registry for Idiopathic Pulmonary Fibrosis (IPF), participating in audits and assisting those involved in individual research.
In March, as the numbers of hospital admissions for COVID-19 started increasing, it became clear that most non-COVID-19 research would temporarily stop, and our clinical responsibilities would change. Around this time, due to our experience with non-invasive ventilation, some of the nursing team became involved in helping to deliver an education programme for Continuous Positive Airway Pressure (CPAP). This is a type of ventilation used to support patients in respiratory failure and it was used for COVID-19 patients. We helped to train over 100 clinicians on many different devices in just a few weeks. One of the devices was the life-saving Ventura CPAP designed by UCL very early on in the pandemic and sent to 30 different countries worldwide.
Once training was completed, we worked on the Respiratory High Dependency Unit (RHDU). This unit was set up to support COVID-19 patients requiring CPAP. Other team members were able to cover clinical posts remotely, which enabled patients to be able to continue to have vital telephone support during this time. One of our research nurses was able to help support the emerging COVID trials. Our administration team were asked to work remotely, but continued to provide support by ensuring that the nurses’ emails were attended to, and urgent messages relayed. Everybody played a vital role.
Working on the wards again was an interesting experience. There were certainly some challenging aspects. Long shifts and night duties (after 16 years) took some getting used to. I re-discovered the energising effects of ‘red bull’ at 3am, although it didn’t quite give me wings! Working in full PPE had its challenges, although it was reassuring and we felt protected wearing it. It took some time to ‘don’ on and ‘doff’ off, but fortunately there were staff to support us with this dressing task. PPE was incredibly hot, and the masks could cause considerable discomfort when worn for long periods. PPE made it difficult to identify people and to be able to communicate effectively, especially to people working outside of the COVID area. However, the challenges were overcome. We quickly started writing names on our gowns, and some even attached photographs of themselves. Barrier cream was supplied for our sore noses, and regular refreshment breaks were provided to allow staff to rehydrate; 2 hours was really the maximum time it was comfortable to spend in full PPE.
Communication issues were addressed via technology with varying degrees of success. It took some skill to master the walkie talkies which connected us to outside areas and sometimes it was just easier to write a note on pen and paper and hold it up against the glass entrance door when a message was needed to be conveyed to the outside world. Technology was of course very useful in terms of keeping patients connected with their families and friends at a time when visitors were not routinely allowed on the wards. Although there were some very difficult situations, it is easy to imagine how much harder this would have been had the pandemic occurred a decade or two earlier.
As a team, we will all have our individual memories of our time in the RHDU. Some of these memories will be about the intensity of the situation, and the experience of caring for patients with severe breathlessness on CPAP. However, many of these memories will be of positive events. It was always a lovely moment when patients were discharged and we were able to clap and say farewell to them, especially to those who had been on the unit for a long and difficult time. For me, a special moment was seeing a patient being interviewed on the BBC, discussing his recovery with the physiotherapy team. I had been on duty the night he had arrived from Intensive Care, with a tracheostomy. It was incredible to think of the journey he had been on, and so pleasing to see his progress. It’s rare that ward nurses find out what happens to patients after they have been discharged, so this was very uplifting.
Despite the difficult situation, there was a great sense of teamwork throughout our time on the RHDU. It was a privilege to work with so many other members of the multidisciplinary team, many of whom were also redeployed and were undertaking roles so different to their own. The psychology team were available to support staff and I know that they were valued. We were well looked after on the ward, with constant deliveries of donated hot meals, and refreshments. Things like this really were appreciated and gratefully received, taking the little stresses out of the day. Other things that made life easier were incentives such as free taxis and parking, to be able to drive to work and not have to consider getting the underground for a few weeks really made travel easier and safer.
Guiding the team through this uncharted territory could have been a very difficult experience, as it was an ever changing landscape and it was not clear how long the situation would continue. However, each and every one of the nursing team showed an enormous amount of flexibility, patience and resilience, and they should be very proud.
Whilst we cannot be sure what lies ahead, we will continue to contribute to the research agenda, as this is such a pivotal part of healthcare. Never has there been a time when research was more important. Research can and will save us from this fatal virus – there are now better treatments for COVID-19 and there are new vaccines on the horizon, and very soon we will feel safe once more.