On the frontlines with vulnerable patients
NOW MORE THAN EVER, NURSES FACE NEW CHALLENGES WHEN CARING FOR PATIENTS WHO ARE IMMUNOCOMPROMISED
While struggling through this COVID-19 crisis is challenging, confusing and frightening for everyone, those feelings are naturally intensified for those with immunodeficiencies, who are potentially more vulnerable to the virus. Likewise, health professionals working with these populations are facing many additional challenges and demands.
Deanna Clatworthy, a registered nurse and a registered practical nurse, is clinic manager for the ARCH Clinic, providing programs, services, education and support for people living with, affected by and at risk of HIV/ AIDS. The regional clinic serves Guelph, Wellington-Dufferin and Grey-Bruce counties.
“We provide specialized care for those who are HIV positive and those affected by HIV, such as their partners and children, providing support and care to deal with their unique needs,” explains Clatworthy. The clinic provides holisitic support for this high-risk population, which also includes LGBTQ+, IV drug users and other marginalized populations.
Besides looking after the health care needs of patients and managing clinic operations, an important aspect of Clatworthy’s work is education around HIV/AIDS. “It’s important that people understand that HIV is no longer a death sentence. It’s a manageable chronic illness. Folks with HIV are living healthy, long lives. But there are still stigmas associated with HIV and part of my role is to educate those within the health-care system and the public about HIV today, about how treatments have changed.”
Prior to the onset of the COVID-19 epidemic, Clatworthy’ s day consisted of seeing patients in her nursing role, including triage, vitals, medication management, dealing with mental health and other challenges. She also coordinated their specialist appointments, did follow ups with hospitals and other organizations involved with patients’ holistic care. “What’s unique about our clinic is that we are co-located with an AIDS service organization, providing things like gas cards to get to appointments, grocery certificates and food hampers.”
Besides all that, Clatworthy also has clinic operations to manage, including funding, coordination of staff and training.
“It’s a lot of juggling. We have a different doctor or specialist here every day seeing patients — one day a specialist seeing transgender patients; the next, a doctor seeing HIV positive patients. The next day might be a psychiatrist; a dietitian; a nurse practitioner providing HIV-primary care. It’s a different clinic every day, plus I’m seeing my own patients. Supporting our patients can be very complex and isn’t confined to a work shift like 9 to 5 or 7 to 7.“During the best of times, Clatworthy is communicating with patients 24/7 via email.
Since COVID-19, things have changed significantly for Clatworthy and the clinic team. They are not seeing patients in the same way they used to — now most communication with patients is done over the phone. “Our patients are immunocompromised, so they are particularly at risk. In order to keep them safe, we want them to stay home. But not all our patients are privileged enough to have a computer, or, in some cases, even a phone. So our challenge is to make sure they aren’t slipping through the cracks, and ensure they’re being cared for.“
With so many medical specialty services and procedures now inaccessible, the patients of ARCH Clinic are depending on the staff and services there more than ever. “We’re trying to manage their other health care needs because now they don’t have the layer of specialist support. Added to all this is the fact that our doctors are infectious disease specialists, so with COVID-19, they’re all extremely busy working in the ICUs.” The clinic is also managing more additional services, such as testing for STIs, since Public Health is so overburdened with COVID issues. All of this means Clatworthy is busier than ever dealing with a brand-new set of challenges.
To compound these issues is patient fear about COVID-19 for this population. “We used to send out a newsletter every other month. Now, newsletters are going two or three times weekly to help manage confusion and fear by keeping patients informed.”
Things have changed drastically, and Clatworthy believes that beyond COVID-19, nursing will look different moving forward. “In the short term, the affects of isolation and lack of social support will affect everything we do. Also, the way we’ve been delivering health care will change. Much more support will be required, since delivering treatment won’t be so patient in, patient out.” Ultimately, Clatworthy believes these changes may have some positive effects for the health care system, and she is hopeful for a bright future for nursing.