OT Week and The Impact of COVID-19: Nicky Bukowski - Rheumatology

The COVID-19 pandemic has affected us all in ways we couldn’t have imagined back when the first lockdown started in March. Over that last 7-8 months, we have all come together as a community to learn how to adapt and to cope with the stresses that the virus has put onto our everyday ‘normal’ lives.

As we adjust into the ‘new normal’ (again), and to mark the start of OT Week, I, along with my expert OT team at Julie Jennings and Associates, have reflected on how the Coronavirus pandemic has affected our work, and what we are doing to make sure we continue providing our vital services safely to those who need it most.

Across OT Week we will be highlighting each of the individual roles we undertake, to give a broader picture of life as an OT during the pandemic.

Name: Nicky Bukowski

Area of work:  14 years clinical experience in out-patient rheumatology services based within Mid Yorkshire Hospitals NHS Trust.

Background experience: Prior to this, I worked in in-patient care of the elderly, adult medicine and orthopaedics / surgery; in-patient and community mental health services. I have also worked as a Community OT, and spent 8 Years working within the Medico Legal field, alongside NHS employment.

Impact of COVID-19 on working practice or your personal perspective

Throughout the pandemic I have remained working within the out-patient rheumatology therapy service; I have also undertaken 3 medico legal cases.

With COVID-19 in the news, but prior to lockdown, a significant amount of time was spent screening out-patient referrals to determine those deemed as vulnerable. As many of my clients have autoimmune conditions, the risk of COVID-19 infection was high, therefore treatment approaches were carefully considered. For those that attended appointments, care was taken to plan quieter times in the department whist others were seen via telephone or given advice by post. Less urgent cases were placed on a waiting list. As a senior clinician I had to ensure the department was as COVID-19 secure as possible (maintaining social distancing, applying PPE, setting clinic guidelines) and then ensuring patients complied with infection control measures,

The impact of the above work was huge as it was done in addition to already full pre-booked diaries, which lead to stress and fatigue. Risk assessment and risk management processes were being implemented, and as a senior clinician I spent time supporting junior staff to process what was ahead of us. Once we moved into lockdown, I was initially advised by my GP to remain off work as I awaited the outcome of tests. Under normal circumstances I would have remained well enough for work. The 3 weeks I spent at home were extremely difficult with guilt and worry about my colleagues continuing to work in difficult and challenging times. Being ‘out of the loop’ also made the anxiety of going back into work extremely difficult.

Initially no assessments / treatments were undertaken much to the frustrations of all staff who were concerned about patients. Many therapy staff were re-deployed to other sectors to assist where they could. Morale became low and the atmosphere tense as staff became aware of the impact of COVID-19 on patient deaths, colleagues contracting the infection and concerns over PPE shortages. The possibility of redeployment was ever present, adding to stress levels.

My rheumatology OT team were the first out-patient therapy team in our service to be advised by the Bronze Command senior management board to commence telephone / video assessments with patients. At this stage things changed. Whilst we were not seeing patients face to face, we were still offering OT treatment. I found patients were appreciative of our attempts to maintain a service. More recently, we have provided support to patients about overcome their fear of leaving the house.

Many clients did not have access to video facilities and therefore telephone assessments were undertaken. This made me realise / appreciate how much I rely on observation when assessing a patient. Over time, assessments have actually become harder and more intense due to patients frustration / anger (feeling abandoned when they were in need); increased symptoms (due to lack of access at crucial times); physical and mental deconditioning (through lack of occupation); assessor stress / fatigue.

Initial assessments are continuing by telephone / video for the foreseeable future with some face to face access possible with full PPE. Rheumatology is a clinical area that requires therapy support taking into account physical, mental, emotional, social, domestic, occupational and personal health needs, It has become very noticeable how much more time I am spending supporting mental health needs due to COVID-19.

As the pandemic is far from over and our waiting lists have reduced significantly, my team are turning attention to people on our caseload who are waiting for home visits and pain management education. These clients have been waiting for input for several weeks / months. Work is going on currently about how we can safely work between the hospital site and community and also deliver group education sessions; virtual and face to face.

Your OT perspective and what you can do to positive influence challenges imposed by the pandemic

There are benefits to telephone / video assessments for patients with less complex needs; absent the COVID-19 pandemic this may never have been tried. Currently, we are looking at adopting an initial telephone triage approach to determine what type of contact a patient may require. The pandemic has also influenced how we currently assess / treat patients: face to face -v- virtual groups, face to face -v- telephone / video assessments, pre-recorded education videos, patient education booklets. We have been able to reduce waiting lists significantly and with different approaches going forwards we should be able to manage the pressures of higher service demand.

There is more information available regarding the effects of Long COVID-19; I believe OTs have the holistic skills, training and knowledge to support, rehabilitate and re-able these clients to progress. I will be able to use these skills within my clinical and medico legal work as well as those I come across in my personal life. 

Your commitments to support the recovery of People that have been affected by the COVID-19 pandemic

I will continue to maintain a high level of support for my patients / clients in all areas of my work, offering different treatment modalities to ensure their needs are met.  I will continue to look at how treatment is effective using reflective practice. I will support the health and well-being of clients and their families through information and training and ensure my knowledge remains up to date within my clinical field as well as the long-term impact of COVID-19 – using evidence, research, up to date guidance as relevant.