For public health nurses serving the city and county, awareness of the challenges faced by their vulnerable patients throughout lockdown, and the desire to resume services put on hold for months during the Covid-19 response, is balanced against concerns that the Rebel County could see a further outbreak.
Although public health nurses continued a range of vital community services including antenatal home visits, palliative care and home visits to the elderly throughout the crisis, many other regular services were paused. Public Health Nurse Managers Judy Purkiss and Martina Corcoran both have a wish list of services they hope to be able to resume safely as soon as they are able.
“For the elderly, I think the social isolation has been so big and having day centres opened would be a huge help,” Judy Purkiss says.
“Lots of elderly clients use the daycare centres as a social outing. It might seem like a small service, but it’s a huge thing in the life of someone when it’s their only trip out in the day, or the only thing they can do independently.”
Judy is Public Health Nurse Manager for the Blackrock and Mahon area, where a team of 15 public health nurses serve a community of 34,000 people. The area has around 4,000 vulnerable people, including the elderly, new mums, and children with disabilities and complex medical needs.
Normally, Judy’s nurses see between eight and ten patients per day, alongside other duties like running child development clinics, breastfeeding groups, wound clinics and antenatal classes. Turner’s Cross daycare centre and Cork city’s homeless services are also in her catchment area.
Martina Corcoran is Public Health Nurse Manager for the Bandon and Kinsale area, where 16 nurses serve a community of 37,000 people in a broad geographical area, with a similar active caseload to Judy’s.
Martina is acutely conscious of the impacts of pausing regular developmental checks for babies and small children.
“We’re very keen to start up our developmental clinics,” Martina says.
“Hearing screening, eye screening, developmental delays: there are subtle physical differences in a child’s development picked up at these check-ups. We also do a huge amount with nutritional education, safety and parenting skills at those clinics too, so we’re very anxious to restart that.”
First baby visits to households with a newborn, conducted by a nurse within 24-48 hours of baby going home, were continued throughout the restrictions. For many new parents, celebrating the joy of their new arrival was impacted by social distancing, with family members unable to visit.
“We normally see family, grandparents and friends become a big support in the postnatal period and that, unfortunately, was taken away from a lot of people,” Judy says.
“The postnatal time can be difficult as well as lovely for a lot of new parents and all kinds of support groups, like the CUMH breastfeeding support group, were paused, so we did more support in the home and over the phone.”
But, Judy says, her nurses reported that some new mums benefited from the extra time to bond with their baby.
“One of our breastfeeding support staff said lots of mums were very contented because there was no social pressure on them to be the perfect mum,” she says.
“There was no pressure on them to go anywhere. They could just be at home, the house could be a mess because there were no visitors, and the babies were happy because there was a lot of bonding.”
While some new mums might have benefited from the conditions of lockdown, there are many other groups that have been and will continue to be heavily impacted by the Covid-19 crisis, both Judy and Martina note.
Respite care for home carers looking after vulnerable adults was paused, and breaks in educational services for children with ASD (Autism Spectrum Disorder) caused huge challenges for families.
And for the families of children with complex medical needs, life won’t be going back to normal any time soon, Judy points out.
For the elderly who have been cocooning, Martina says: “Isolation and loneliness continue to be a concern, and so is deconditioning in clients who haven’t been out in the last three months. Physios had a lot of concerns and did a lot of remote work in terms of giving advice on exercise and the like, so elderly people didn’t become overly deconditioned during the time we were trying to keep them safe.”
Elderly patients may not always respond well to remote services over the phone, Judy points out: “A lot of elderly people would say, ‘I’m grand, nurse, no need for a visit.’ But when you get there it’s a totally different story. We encouraged all our nurses to do quick visits, because some people who say they’re grand could actually be in a bad way and in need of assistance.”
Nurses did Covid-19 assessments over the phone before home visits, and wore full PPE if there was a suspected case, Judy says.
“There was a lot of training in infection control to protect patients and staff,” she adds.
Judy and Martina were instrumental in setting up Ballincollig Community Assessment Hub, one of four nationally commissioned Covid hubs for Cork city and county, designed to ease the pressure on acute services by assessing and treating milder Covid-19 cases referred by GPs. The hub was built from scratch in a matter of weeks, an “amazing feat of workmanship from the builders and maintenance and all the disciplines in the HSE,” Martina says.
Plans to staff the hub seven days a week from 8.30am to 7.30pm have not been enacted, due to low numbers of community transmission. St Mary’s Health Campus in Gurranabraher is the only hub to have opened in Cork county, with hubs in Bantry, Ballincollig and Mallow remaining closed.
“Thankfully, we didn’t have the numbers when it came to the time to open it,” Martina says. “We haven’t had a need for a second hub. If the numbers reached those of other countries, we would have been caring for Covid patients in the community and managing symptoms at a local level to take the burden off the acute services; we had to plan for that.”
Cork may appear to have fared quite well in terms of community transmission of Covid-19 to date; even though it has 11.5% of Ireland’s population, according to Census 2016, it has had 6% of all Covid-19 positive test results reported in the Republic of Ireland. The CSO reports that there have been just over 40 Covid-related deaths in Co Cork since March, when the first Irish positive test result was reported. Is it possible we may have escaped the worst?
Judy says it’s far too early to say.
“The HSE is prepared to turn around at any moment and go back to the way things were a few weeks ago,” she says.
“The Covid assessment hub is still on standby, so all the staff who were deployed there will be available if numbers in the community rise again.
“In my opinion, we didn’t need the hub because everybody was really good at working together to protect the vulnerable. The lockdown was early and people really were very good overall at following instructions on social distancing.”
For the public health nurses themselves, continuing to serve their communities throughout the crisis has meant considerable personal sacrifice and risk, Martina says.
“The fear, especially at the start, was one of the things everyone struggled with,” she says. “In a time when everyone was being told to stay indoors to look after themselves, we were asking our staff to come out and put themselves and their families at risk. We had staff who themselves were going home to vulnerable family members, so the psychological toll was huge but every nurse showed up to work.
“From a nursing point of view, I couldn’t say I’m prouder of the staff and the commitment they give to the role. The team work I saw is something that will stick with me and that we’ll be proud of for a very long time.”