Innovative solutions are needed for the continuation of preventative and other primary care services during a pandemic. Simultaneously, infection prevention and control and pandemic preparedness need to be emphasised in undergraduate and postgraduate curricula. These were among the conclusions reached in a Western Cape Covid-19 primary care study.
It also appears that there is a need for greater workplace support as far as nurses' mental health is concerned, Dr Talitha Crowley – a senior lecturer in the Department of Nursing and Midwifery of Stellenbosch University (SU) – said.
She announced the preliminary study results in her presentation on primary care nurses' preparedness for Covid-19 and the impact on Western Cape primary care services at the Annual Academic Day of the Faculty of Medicine and Health Sciences.
The data were collected between 30 June and 31 July – when Covid-19 was at its peak in the Western Cape – at the initiative of the Department of Nursing and Midwifery and in collaboration with the Department of Global Health. The study entailed an online survey among postgraduate diploma students in primary care at SU as well as alumni from the 2017-2019-year groups.
As the first point of entry into the healthcare system for many patients, Crowley emphasized, primary care nurses play a pivotal role in infectious diseases. The South African health system is already heavily burdened with various preventative and curative services, including chronic care. The reality is that essential primary care services had to continue despite the additional workload brought about by the Covid-19 pandemic, while at the same time nurses had to manage their own risk of contracting the virus.
Nearly 60% of the 82 participants in the study mentioned that Covid-19 affected other services, with more than 45% reporting that the service quality was worse than before. Most facilities were forced to reorganise health services due to Covid-19, amongst other to team up with non-governmental organisations for home delivery of medication and the cessation of certain outreach activities.
There was general concern about patients with HIV, TB and those in need of chronic care. Some nurses were also concerned about the long-term impact of the unavailability of services for baby wellness as well as sexual reproductive health during COVID-19.
In terms of Covid-19 training, between 40% and 58% felt they were adequately prepared to provide the necessary care. This was in line with the findings of a similar British study. Yet 12.2% of respondents received no training. The most common method of training was an instructional video. Participants indicated a need for formal training and for specific topics, for example the difference between how adults and children present.
Among the challenges experienced was dishonesty about symptoms. Due to fear of being denied help, some patients disclosed their Covid-19 symptoms only when in consultation at the primary care health facility.
A large percentage of nurses had access to guidelines on how to triage and manage Covid-19 patients, although the facilities' infrastructure was not always taken into account and guidelines in future may need to be adapted to the relevant phase of the pandemic. Challenges with infrastructure were experienced, especially in the smaller and mobile clinics.
Almost 60% of the respondents indicated that personal protective equipment (PPE) was always available. However, the lack of PPE was a general concern and in some instances this led to theft of items, which necessitated the locking away of equipment.
The greatest need in terms of working conditions was support with stress management. Although 40.3% of respondents experienced Covid-19-related stress frequently or very frequently, only 16% indicated that they had mental health support in the workplace. About 60% had to self-isolate at some stage, with more than a fifth having fewer opportunities to rest than usual.
The lessons learned from this study may assist in preparing primary care facilities for the National Health Insurance, Crowley said. Strategies implemented during the Covid-19 pandemic need to be studied, including collaboration between the private sector, non-governmental organisations and public health clinics, and the use of testing centers. However, more research, especially of a qualitative nature, is needed.