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Clinical guidance for managing COVID-19
Information for RCN members
All nursing and midwifery staff are fundamental to informing the public and reassuring them about the COVID-19 outbreak.
This page is part of the RCN COVID-19 (coronavirus) resources. It provides RCN members across the health and social care workforce, including nursing support workers and students, with clinical information and key resources to support their understanding of and help them with management of coronavirus disease (COVID-19).  
Also see: 
RCN position on COVID-19
RCN COVID-19 and vaccination FAQs
Background
In late December 2019 a new (novel) coronavirus was identified in China causing severe respiratory disease including pneumonia. 
The virus causing the infection has been named - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the cause of this new strain of coronavirus disease COVID-19.
The situation was declared a pandemic by the WHO on 12th March 2020 (Pan being all and demos people).
See the global data: WHO dashboard and WHO situation reports dashboard and Johns Hopkins University dashboard.
Coronavirus
Coronaviruses are a common family of viruses and one of the causes of the common cold. In general, most people with COVID-19 will present with mild to moderate respiratory like symptoms, but older people, those with underlying illness and co morbidity are more likely to develop serious illness (see the WHO information). 
Other examples of Coronavirus infections include Middle East respiratory syndrome coronavirus (MERS-CoV) and the first outbreak of Severe Acute Respiratory Syndrome (SARS -1) both of which have prompted global collaboration to reduce spread between people and to protect healthcare workers and continue to do so.
Current situation
COVID-19 remains a fast-moving evolving situation and the epidemiology of the infections change rapidly across the world. This is as a result of the natural progression of an infectious disease with waves of high infection exposing those susceptible and identification of new variants to the original coronavirus infection adding a further potential risk. Additional impacts are caused by Non Pharmaceutical Interventions (NPI) such as the closure of all but essential business, social distancing and reducing unnecessary travel, alongside new treatment options and the impact of vaccination.
As such, any COVID-19 guidance for healthcare workers and health and social care services is evolving and being updated frequently. This reflects the need to take a view of the global situation (see: the WHO coronavirus hub) as well as the situation across the UK.
Also see: RCN FAQ on ‘support for nursing staff managing changing the global situation’.
All nursing and midwifery staff, including, nursing associates (England only), and healthcare support workers, must familiarise themselves with their local policies on emergency planning and infection prevention and control. They should also keep up to date with national guidance issued by the UK governments and relevant UK Public Health agencies. 
This information is updated regularly to reflect the changing situation but it is imperative that members look on source web sites and check the embedded links to ensure they are looking at the most up to date information.
UK Coronavirus response
The UK plans and actions for managing the coronavirus (COVID-19) outbreak, are available here with links to country specific public health guidance.
Public information campaign
The Department of Health and Social Care public information campaign including the importance of handwashing and other measures to reduce the spread of coronavirus.
See: Coronavirus (COVID-19): campaign information and resources.
For health protection advice, contact your local health protection team:
- Find your local health protection team in England
- Health Protection Scotland: enquiries
- Health Select Committee Northern Ireland health protection
- Public Health Wales: contact us
Information for the public
Anyone concerned about symptoms in themselves or someone they know should be advised to contact NHS 111.
Also see ‘What to do if you have symptoms’:
The Department of Health and Social Care public information campaign including the importance of handwashing and other measures to reduce the spread of coronavirus.
See: Coronavirus (COVID-19): campaign information and resources.
This PHE video explains how to improve ventilation in the home
For specific health protection advice, contact your local health protection team:
- Find your local health protection team in England
- Health Protection Scotland: enquiries 
- Health Select Committee Northern Ireland health protection
- Public Health Wales: contact us
RCN position
The RCN are working with national UK agencies and other key stakeholders such as other Royal Colleges and professional organisations to support preparedness and management of the current situation providing a nursing-focused perspective based on our role as a Royal College and Trade Union. 
The protection of healthcare workers, development and review of guidance and resilience of healthcare workers and healthcare provision are key for the RCN.
Please refer back to the main RCN COVID-19 (coronavirus) resource.
RCN position on COVID-19 & RCN COVID-19 FAQs
The detail below provides more specific information and access to further resources.  Please also see the relevant clinical topic pages for additional information.
COVID-19
Employment advice
- COVID-19 FAQs
- COVID-19 and vaccination
- COVID-19 and staffing levels
- Long COVID
- Employment guidance for NHS staff
- Individual risk assessments
- Nursing students & trainee nursing associates advice
- Personal protective equipment (PPE) advice
- Redeployment guidance
Clinical guidance
- Managing COVID-19
- COVID-19 vaccination
- Prescribing safely under COVID-19
- DNACPR & verification of death
- Mental health care delivery
Our work
- COVID-19 inquiry
- Our COVID-19 position statements
- Open letters
- Media statements
- Campaigning during COVID-19
Supporting you
RCN COVID-19 Independent Review
Resources developed by RCN Northern Ireland
These resources were made at the very beginning of the first surge and whilst the NIV video remains useful, it should be recognised that the equipment is used in a CPAP mode and not bi-level pressure.
This BTS guidance was released after we made the videos.
Organisations may use different models on CPAP but all the general principles remain the same.
RCN Infection Prevention and Control Programme
Find out more about the RCN's introductory module to infection prevention and control.
RCN hand washing poster
An A4 poster detailing the 10 steps to effective hand washing. We recommend laminating this poster if displaying in wet areas.
UK governments are working to develop guidance and information:
- GOV.UK: Coronavirus: latest information and advice - Current situation in the UK and actions taken in the UK and abroad.
- DHSC & Public Health England (PHE): Coronavirus and vaccine data England
- Scottish Government data and information
- HSC Public Health Agency (Northern Ireland): COVID-19 (coronavirus)
- Public Health Wales information
- International Council of Nurses: Protecting nurses from COVID-19 a top priority: A survey of ICN’s national nursing associations
- European Centre for Disease Prevention and Control (ECDC): COVID-19 
- PHE: COVID-19: stay at home guidance 
- Scottish Council for Voluntary Organisations: COVID-19 Third Sector Information Hub
- Scottish Social Service Council: Guidance to help social workers respond to COVID-19 (coronavirus)
- Scottish Government: Coronavirus social care guidance including Clinical Guidance for Nursing Home and Residential Care Residents 
- World Health Organization (WHO): Novel Coronavirus (2019-nCoV) advice for the public
- England: Care Quality Commission (CQC): Inspections information 
- Northern Ireland: Regulation and quality improvement authority
- Scotland: Care Inspectorate: COVID-19
- Wales: Care Inspectorate COVID-19
- Coronavirus (Covid-19): Apprenticeship Updates
- HEE information and resources to support COVID-19
- HEE e-learning modules to support COVID-19
- NHS Education for Scotland: TURAS Learn Coronavirus COVID-19 Learning Portal resources and information for health and social care staff
NMC: Coronavirus (Covid-19): Information and advice
CPR position and NMC code
During the COVID-19 pandemic, some people will become critically ill and their clinical progress, or lack thereof, will prompt frequent review of their likelihood of benefitting from cardiopulmonary resuscitation (CPR). These reviews and discussions should be communicated with patients and their family members, documented and decisions should be easily accessible to all staff (such as Advance Care Plans, Advanced directives including ReSPECT documents or equivalent). All healthcare establishments have policies in place around CPR and guidelines on attempting CPR.
Registered nurses have reported that local CPR policy may differ from national guidance, raising concerns that following local or national guidance could mean criticism either way and breach of the NMC Codehttps://www.nmc.org.uk/standards/code/. The RCN and NMC issued a joint statement to support decisions relating to Cardiopulmonary Resuscitation.
Due to the pandemic waves, resource and manning constraints in the surges of critically ill coronavirus patients has seen conflicting CPR guidance is circulating nationally. Current Resuscitation Council UK guidance maintains early CPR and defibrillation gives people the best chance of survival and reiterates that all conversations and decisions around CPR are individual to the person involved; a blanket approach to decisions on whether or not to resuscitate individuals in an emergency is not supported. The RCN, NMC and GMC are unanimous in the use of advance care plans being made with people and patients, and are explicit that decisions must be made on an individual basis.
The NMC has re-iterated that all registrants are to use their professional judgement to decide what action should be taken in the best interests of the person in their care. Standards in the Code must continue to be upheld as they are useful to support decision making.
The RCN view is that registered nurses (and Nursing Associates in England) should use their professional judgement to provide CPR or not, taking into consideration the individual needing CPR, the current situation and environment they are in and local policy. Provided the registrant can justify their actions based on these judgements, they should not face criticism.
Additional guidance is available in the collaborative document - Ethical dimensions of COVID-19 for frontline staff.  
- GOV.UK: COVID-19: investigation and initial clinical management of possible cases
- Health and Social Care Public Health agency in NI (HSCNI): Health protection guidance
- Health Protection Scotland (HPS): Coronavirus (COVID-19): Coronavirus (COVID-19)
- Public Health Wales: Latest information on Novel Coronavirus (COVID-19)
- PHE: Novel coronavirus: what you need to know. Q&A blog updated by PHE
- Public Health Wales statement on Novel Coronavirus (COVID-19) daily update
Department of Health and Social Care, Public Health Wales, Public Health Agency (Northern Ireland), Health Protection Scotland and Public Health England joint UK advice:
- COVID-19: infection prevention and control (includes guidance on the correct use of PPE)
- RCN Personal protective equipment (PPE) advice
- RCN Skin health toolkit
Also see:
- RCN: Uniform and workwear guidance
- RCN: Essential Practice for Infection Prevention and Control
- Healthcare Infection Society: Coronavirus resources.
- Medicines and Healthcare products Regulatory Agency: Don’t rely on temperature screening products for detection of coronavirus (COVID-19)
- NHS England & NHS Improvement: Infection prevention and control board assurance framework
Please see our guidance on PPE.
People previously considered to be clinically extremely vulnerable will not be advised to shield again, as the government agrees to end the requirement for centralised guidance for these groups following expert clinical advice.
See: GOV UK. Shielding programme ends for most vulnerable and UK Parliament. Written statements. COVID-19 update.
There is separate advice available for example: Kidney Care UK. Closing the shielding programme in England.
Further resources:
NICE Coronavirus (COVID-19) rapid guidelines and evidence summaries, including:
- Critical care
- Dialysis service delivery
- Delivery of systemic anticancer treatments
- Managing suspected or confirmed pneumonia in adults in the community
New variants of SARS-CoV-2 have been identified since the initial emergence of infection in December 2019. Some of these variants have been associated with rapid increases in the spread of infection. These are likely to cause further waves in the future across the UK or in local regions. When rapid increases in infection rates of SARS-CoV-2 variants happen, critical care and emergency department nurses are likely to be looking after more acutely and critically unwell patients. Nurse to patient ratios have been much higher than usual and they may again if we continue to have new variants rapidly increasing infection rates. Additional critical care capacity may again require support from colleagues from other specialties not necessarily related to emergency or critical care. Therefore, RNs may have to supervise non-emergency/critical care colleagues moved to support the care delivery to the critically ill patients in their departments.
Please see:
- CC3N, Coronavirus (Covid 19) Resources & Guidance
- CC3N, National nurses leads guidance for COVID-19
- DHSC, COVID-19 Hospital Discharge Service Requirements
- UKCCNA ,Position Statement: Nurse Staffing during COVID-19: Jan 2021
RCN e-learning
Two RCN e-learning programmes are available to support nurses in critical care during the pandemic:
- ‘Introducing Critical Care’ provides flexible and accessible learning resources to support an introduction to critical care for the nursing and midwifery workforce.
- ‘End of life care and wellbeing for the nursing and midwifery workforce’ supports the delivery of end of life care to the dying person, their family and carers.
See also: Nurse staffing ratios in ICU revised to help manage second surge of COVID-19
National Early Warning Score 2 (NEWS2)
Read information from the Royal College of Physicians (RCP) National Early Warning Score 2 (NEWS2) system which has been developed to improve detection and response to clinical deterioration in adult patients. The system has not specifically been designed for the COVID 19 outbreak but is a vital tool to support clinical judgement with the emergency situations.
Is Nasogastric Tube insertion an Aerosol Generating Procedure?
Currently, Public Health England do not view Nasogastric Tube (NG) placement as an Aerosol Generating Procedure (AGP). The RCN agree with The British Association for Parenteral and Enteral Nutrition (BAPEN) and the Association of UK Dieticians (BDA) that insertion of an NGT regularly induces a cough or sneeze in patients and that this could generate both droplets and aerosols within the range of 1-2 metres required for proximity to the patient during NGT insertion. We have respectfully asked PHE in an open letter to change its guidance to reflect the decisions of the professional bodies representing those who have to insert NGT/NJTs during the Covid-19 crisis.
A significant proportion of patients needing hospital admission with COVID-19 will require oxygen therapy and/or ventilatory support. National guidance for respiratory support of COVID patients is available and up to date. Local guidelines should be in place regarding the management of patients with COVID-19 requiring oxygen therapy. These should outline oxygen flow and potential oxygen demand.
The use of high flow oxygen has significantly increased during the pandemic and there have been concerns that oxygen supply levels in hospitals may not be sufficient to meet the demand. The RCN has been assured that procurement and distribution systems have been put into place to monitor and ensure supply meets demand. 
Resource is sufficient if oxygen is regulated according to individual need. Oxygen delivery systems have a finite capacity; if this is exceeded through unregulated full flow oxygen delivery through all wall outlets, there is a risk of a rapid pressure drop in oxygen supply pipes. Therefore, systems should be in place to check on an individual level that oxygen supply meets and does not exceed the need of each patient e.g. if 15 litres oxygen is prescribed and selected then 15 litres should be delivered via the appropriate regulated mask. Equally, if five litres is prescribed then only five litres should be delivered.   
Organisations should have risk assessments in place alongside risk mitigation strategies in the event of piped oxygen limitations e.g. oxygen cylinders that are full, readily available and replenished regularly.
The following links provide further information:
British Thoracic Society. COVID-19: information for the respiratory community
British Thoracic Society. BTS/ICS Guidance: respiratory care in patients with acute hypoxaemic respiratory failure associated with COVID-19
Healthcare Safety Investigation Branch. Report concludes safety investigation into COVID-19 demands on oxygen delivery in hospitals.
Cancer and Coronavirus (COVID19)
Guidance has been produced by the One Cancer Voice* charities in partnership with NHS England.
Macmillan Cancer Support: frequently asked questions for people with cancer.
Please refer in the first instance to wider Government guidance on:
- Staying at home if you think you have coronavirus (self-isolating)
- How everyone can help stop coronavirus (social distancing)
- How to protect extremely vulnerable people (shielding)
RCN: Remote consultations guidance under COVID-19 restrictions. This guidance has been developed to support nursing staff, including health visitors, midwives and nursing support workers, where they are being asked to see and/or treat patients via a telephone or video or other remote consultation process.
How to differentiate lung cancer from COVID-19
- UKONS Oncology Nursing Society. Differentiate lung cancer from COVID-19: infographic guidance
- Public Health England. Help Us Help You - Lung Cancer Symptoms
National Early Warning Score 2 (NEWS2)
Read information from the Royal College of Physicians (RCP) National Early Warning Score 2 (NEWS2) system which has been developed to improve detection and response to clinical deterioration in adult patients. The system has not specifically been designed for the COVID 19 outbreak but is a vital tool to support clinical judgement with the emergency situations.
Royal College of Psychiatrists guidance for psychiatrists and other healthcare professionals working in mental health settings. Developed with NHS England and Improvement (NHSE/I) and the Royal College of Nursing.
The National Association Psychiatric Intensive Care and low secure units (NAPICU) have developed advice on restrictive practices and managing acute disturbance.
See also:
- RCN COVID-19 Mental Health guidance
- RCN: Remote consultations guidance under COVID-19 restrictions
- Mind: Coronavirus and your wellbeing
- NHS England guidance for commissioners and providers of services for people who use drugs or alcohol
- Updates from the European Centre for Disease Prevention and Control (ECDC) the World Health Organization (WHO)
National Early Warning Score 2 (NEWS2)
Read information from the Royal College of Physicians (RCP) National Early Warning Score 2 (NEWS2) system which has been developed to improve detection and response to clinical deterioration in adult patients. The system has not specifically been designed for the COVID 19 outbreak but is a vital tool to support clinical judgement with the emergency situations.
- Beyond Words: Coping with Coronavirus. Free picture stories and illustrated guides to support people with learning disabilities and autism through the coronavirus pandemic.
- Care Quality Commission: CQC publishes data on deaths of people with a learning disability
- Chris Hatton's Bog. What we know (so far) about the deaths of people with learning disabilities in England during COVID-19
- Department of Health and Social Care: Coronavirus (COVID-19): looking after people who lack mental capacity
- Learning Disability England: COVID-19 hospital Passport
- Learning Disability England: Keeping informed an in touch during Coronavirus
- Learning Disabilities Professional Senate (LDPS): COVID-19: Activity Ideas for people with learning disabilities in in-patent units whilst in isolation
- Mencap. Barriers to healthcare for people with a learning disability during the pandemic
- National Mental Health and Learning Disability Nurse Directors Forum. COVID-19 resources
- NHS England & NHS Improvement. Short film providing information about vaccines: For people with a learning disability and autistic people
- NHS England: Learning disability and autism, dementia and mental health. Patient, carer and family engagement and communication during the coronavirus (COVID-19) pandemic
- NHS England: Learning Disability and Autism COVID-19 webinar slides, Stakeholder webinar slides and Stakeholder webinar transcript
- Office of the Public Guardian: NHS and social care staff: check if a COVID-19 patient has an attorney or deputy
- NHS Scotland: Caring for someone with a learning disability who is self–isolating or social distancing due to risks associated with Coronavirus
- National Mental Health and Learning Disability Nurse Directors Forum: 2020 06 01 LD COVID framework FINAL. Planning and considerations for NHS trusts.
- Public Health England: Learning Disability and Autism Programme FAQ
- Scottish Commission for Learning Disability: COVID-19 Guided Self-help Booklet Series. Self-help booklets supporting people with mild to moderate learning/intellectual disabilities during the COVID-19 outbreak.
- The Challenging Behaviour Foundation. COVID-19 Vaccine: Accessibility and reasonable adjustments for individuals with severe learning disabilities whose behaviour challenges.
Surrey and Borders Partnership NHS Trust: Videos to support people with learning disabilities and families/ carers
- Coming Out of Lockdown
- Explaining Coronavirus for People with Learning Disabilities
- Explaining Social Distancing for People with Learning Disabilities
- Explaining the Tier system in England for People with Learning Disabilities
- Feeling Anxious when coming out of lockdown
- How to manage difficult feelings after coronavirus
- How to support people with a learning disability ease out of lockdown
- Keeping Healthy
- Recovering from Coronavirus
- Understanding depression
- Videos for Carers (Families, Staff, Friends, Advocates) of People with Learning Disabilities
- Faculty of Sexual and Reproductive Health (FSRH) guidance. FSRH patient guide: Advice for women seeking contraception, abortion and other SRH services during COVID-19
- HEE. Coronavirus (COVID-19) information for midwives
- NHS England & NHS Improvement. Maternity care pathway in quarantine hotels
- Royal College of Nursing: Redeployment guidance for pregnant staff (under 'What are the occupational health / health and safety factors?')
- Royal College of Obstetricians and Gynaecologists: National guidance on managing COVID-19 infection in pregnancy
- Royal College of Obstetricians and Gynaecologists: Guidance for pregnant health care staff
Further information is also available from:
- Beyond Words: Coronavirus resources for secure settings
- Department of Health and Social Care: Coronavirus (COVID-19): looking after people who lack mental capacity
- HM Inspectorate of Prisons (HMI): COVID-19 update
- Independent Advisory Panel on Deaths in Custody: 'Keep Talking, Stay Safe': A Rapid Review of Prisoners' Experience under COVID-19
- Ministry of Justice, PHE, and Her Majesty’s Prison and Probation Service: COVID-19 population management strategy for prisons
- Ministry of Justice and Her Majesty's Prison and Probation Service: COVID-19: National Framework for Prison Regimes and Services. This Framework sets out how we will take decisions about easing coronavirus-related restrictions in prisons.
- Ministry of Justice and PHE: COVID-19: prisons and other prescribed places of detention guidance
- NHS England: Health and Justice
- NHS England: Remote prescribing guidance for health and justice site
- NHS England: Accessing medicines for detainees released during COVID-19
- Prison Reform Trust. The pandemic: one year on
- Public Health England: Health and social care needs assessment of adults under probation service supervision in the community
- RCGP: COVID-19 guidance for healthcare in secure environments
- Shona Minson, British Academy Post Doctoral Research Fellow. The impact of COVID-19 prison lockdowns on children with a parent in prison
- UK Health Security Agency. Management of acute respiratory illness in prisons and places of detention
- Zahid Mubarek Trust. A record of our own: lockdown experiences of ethnic minority prisoners
- RCN: Prescribing safely under COVID-19
- RCN: Maintaining the National Immunisation schedule during COVID-19
- RCN: Remote consultations guidance under COVID-19 restrictions
See also:
- AHSN Network. COVID oximetry and virtual wards
- Association for Palliative Medicine: COVID-19 and Palliative, End of Life and Bereavement Care in Secondary Care - 20 April 2020
- COVID EoLC Community Charter
- DHSC: COVID-19 Hospital Discharge Service Requirements
- DHSC: Coronavirus (COVID-19): adult social care action plan
- FSRH Position: Essential SRH Services during COVID-19 March 2020
- JCVI: Statement on immunisation prioritisation
- NHS England: Novel coronavirus (COVID-19) standard operating procedure: Community health services
- NHS England and NHS Improvement. Principles of safe video consulting in general practice during COVID-19
- NHS England and NHS Improvement. After-care needs of inpatients recovering from COVID-19. This guidance supports primary care and community health services to meet the immediate and longer-term care needs of patients discharged following an acute episode of COVID-19, by describing the typical expected health care needs of these patients, post-discharge.
- NICE: COVID-19 rapid guideline managing suspected or confirmed pneumonia in adults in the community
- PHE: Health and social care needs assessment of adults under probation service supervision in the community
- PHE: Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19
- RCGP: Community Palliative, End of Life and Bereavement Care in the COVID-19 pandemic
- RCGP: End of life and palliative care toolkit
Surrey and Borders Partnership NHS Trust: Videos to support people with learning disabilities and families/ carers
- Explaining Coronavirus for People with Learning Disabilities
- Explaining Social Distancing for People with Learning Disabilities
- Videos for Carers (Families, Staff, Friends, Advocates) of People with Learning Disabilities
National Early Warning Score 2 (NEWS2)
Read information from the Royal College of Physicians (RCP) National Early Warning Score 2 (NEWS2) system which has been developed to improve detection and response to clinical deterioration in adult patients. The system has not specifically been designed for the COVID 19 outbreak but is a vital tool to support clinical judgement with the emergency situations.
Delivering clinical services in non-clinical areas in General Practice
The RCN recognise that at this time of unprecedented demands on primary care balancing the need to maintain social distancing, while continuing to maintain essential services such as child immunisation clinics has led General Practice to investigate alternative ways to maintain these services. It is recognised that in order to limit the spread of the virus and protect patients and staff it is necessary to reduce footfall and maintain social distancing as far as possible in clinical areas.
We are aware that many patients and the parents of young children are reluctant to attend clinics for childhood immunisations or blood tests due to fears around COVID-19. In order to address this, some general practice surgeries are offering patients services in practice care parks and, in some cases, have been administering vaccines in the client’s car. Other reports suggest temporary tents or gazebos being erected to serve as clinical areas for phlebotomy services for example.
Delivering services in this way requires a number of considerations. The potential risks identified include:
- Maintaining infection prevention control
- Maintaining good documentation and record keeping
- Consent and Confidentiality
- Health and safety of staff and patients including needlestick injury; personal safety, traffic and environmental risks e.g. weather conditions rain/heat, equipment and site security.
- Managing post vaccination anaphylaxis
- Appropriateness for certain groups e.g. Vulnerable adults such as Learning Disability and Dementia patients.
- Safeguarding
Recommendations
Delivering services in different ways is an increasing demand for services during the pandemic. This is to help ensure social distancing as far as possible and minimise footfall in clinical areas.
There are some key considerations staff need to consider as part of the risk assessment for delivering the services in this way. A risk assessment is the responsibility of your employer and needs to be regularly reviewed and updated.
- RCN: Maintaining safe vaccine storage and administration where this is applicable including post vaccination prophylaxis
- Nursing in Practice: Childhood immunisations: How a practice reduced face-to-face time
- PHE: COVID-19: infection prevention and control (IPC)
- RCN: IPC Guidance
- RCN: Safe staffing handwashing guide
- NMC: Maintaining good documentation and record keeping
- RCN: Consent and Confidentiality
- RCN: Health and safety of staff and patients (including needlestick injury; personal safety, traffic and environmental risks e.g. weather conditions rain/heat, equipment and site security)
- RCN: Personal safety when working alone: guidance for members working in health and social care
- HSE: Event safety
- HSE: Controlling the risks in the workplace
- HEE: Sharps injuries
- RCN: Safeguarding of children, young people and vulnerable adults
- DHSC: Dementia friendly environments
The long term impact of COVID-19 is not clear but we know that many patients suffer variety of symptoms and there are studies underway to explore this. 'Long COVID’ is the term used to describe longer term side effects from COVID-19. For more information, see:
- Asthma UK and British Lung Foundation. Latest evidence and guidance for the care and rehabilitation of people with breathing difficulties after having COVID-19
- Carfì A, Bernabei R, Landi F, for the Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020;324(6):603–605
- Homerton University Hospital NHS Foundation Trust. Post COVID-19 Patient information pack. See also: COVID-19 recovery and rehabilitation.
- NHS. Supporting your recovery after COVID-19
- NHS Employers. Joint guidance on the management of long term COVID-19 sickness absences (England only)
- NHS England. National guidance for post-COVID syndrome assessment clinics
- NHSE/I. Post-COVID Syndrome (Long COVID)
- PHOSP COVID - Improving long-term health outcomes. This Post-hospitalisation COVID-19 study is a consortium of leading researchers and clinicians from across the UK working together to understand and improve long-term health outcomes for patients who have been in hospital with confirmed or suspected COVID-19.
- Royal College of Occupational Therapists. How to manage post-viral fatigue after COVID-19. Practical advice for people who have recovered at home
- Royal College of Occupational Therapists. How to manage post-viral fatigue after COVID-19. Practical advice for people who have been treated in hospital
- SAPHNA. Long COVID in children and young people
- SOM. COVID-19 return to work guide For recovering workers. This leaflet offers guidance for workers on how to manage getting back to work after COVID-19 infection and Long COVID.
- Trish Greenhalgh et al. ‘Long Covid’: evidence, recommendations and priority research questions. Written evidence.
- QNI. Living with Covid-19 (Long Covid) and Beyond: Community and Primary Care Nursing Resource
See also:
- King's Fund: Technology and innovation for long-term health conditions
- British Thoracic Society: COVID-19: information for the respiratory community
- NHS England: NHS Improvement & East of England Diabetes Clinical Network: Delivering Diabetes Care during the COVID-19 Pandemic - the 'new normal'
- NHS England: NHS ‘lifeline’ for hundreds of stroke survivors
- UCL Partners: Long-term condition support. Tools and resources designed to enable primary care teams to continue to effectively manage patients with long-term conditions.
Community Nursing in all forms is pivotal to the nation’s health and social care. We have put together some useful UK guidance. However, it is important that the nursing team familiarise themselves with their local policies on emergency planning, infection prevention and control and national other guidance.
You may find useful information on the Queens Nursing Institute website: See: Coronavirus Information Centre. A collection of resources and links for community nurses and allied health professionals.
See also:
NHS England. Community services prioritisation framework.
Coronavirus (COVID-19): guidance for schools and other educational settings. Guidance and advice about coronavirus (COVID-19) in educational settings for staff, parents and carers, pupils and students.
Respiratory illnesses
- RCPCH. National guidance for the management of children with bronchiolitis and lower respiratory tract infections during COVID-19
- e-Learning for Healthcare (e-LfH). Respiratory surge in children
- Overarching guidance for educational settings
- COVID-19 infection prevention and control
- Supporting vulnerable children and young people
- Guidance on specific subjects
- Finance and administration
- Initial teacher training (ITT) and newly qualified teachers (NQTs)
Department for Education:
- Actions for FE colleges and providers during the coronavirus outbreak
- Conducting a SEND risk assessment during the coronavirus outbreak
- Coronavirus (COVID-19): home test kits for schools and FE providers
- What parents and carers need to know about schools and other education settings during the coronavirus outbreak. Information for parents and carers about the wider opening of nurseries, schools and colleges, transport, attendance, free school meals and remote education.
- Actions for educational and childcare settings to prepare for wider opening from 1 June 2020. Next steps for the phased wider opening of educational and childcare settings.
- Preparing for the wider opening of schools from 1 June. A planning guide for primary school leaders to help prepare them to open their schools for more pupils during the coronavirus outbreak.
- Safe working in education, childcare and children’s social care. Preventing and controlling infection, including the use of PPE, in education, childcare and children’s social care settings during the coronavirus outbreak.
- Actions for FE colleges and providers during the coronavirus outbreak. Guidance for further education (FE) providers on maintaining education and skills training, changes to funding arrangements, data collections and assessment.
- Explanatory note on SAGE modelling. An explanatory note for SAGE’s paper assessing the potential impact of more children returning to school on the transmission of coronavirus (COVID-19).
- Transport to school and other places of education: autumn term 2020.
Further resources:
- European Centre for Disease Prevention and Control. COVID-19 in children and the role of school settings in COVID-19 transmission
- Public Health England and the Department of Education. Guidance Coronavirus: travel guidance for educational settings. This guidance is for students, staff and children in the education sector planning to travel in the UK or overseas, and for those who are already overseas.
- See also general guidance for the public: Coronavirus (COVID-19): what you need to do.
- RCN, SAPHNA, CPHVA and iHV. Delivering the school nursing healthy child programme during the covid19 pandemic. Professional advice to support best practice virtual contact by school nurses.
- RCN, SAPHNA, CPHVA and iHV. Working with vulnerable families. Professional advice to support best practice.
- SAPHNA. Long COVID in children and young people
People living with dementia may find changes in patterns of life difficult to manage. It is important to explain to people living with dementia why there are changes are occurring and what is being done to keep them safe. Writing reminders, reinforcing details at each visit and encouraging virtual community support will all be helpful.
- Alzheimer’s society: Coronavirus: Information for people affected by dementia
- Alzheimer's Society: Worst hit: dementia during coronavirus
- British Geriatrics Society: COVID-19: Managing the COVID-19 pandemic in care homes for older people
- Dementia UK: Coronavirus (COVID-19): information for families looking after someone with dementia
- Dementia UK: Calming Techniques. This video provides calming techniques which may help a person with dementia as well as their carer
- NHS England: Dementia wellbeing in the COVID-19 pandemic
- SCIE: Dementia in care homes and COVID-19
- SCIE: Safeguarding adults with dementia during the COVID-19 crisis
National Early Warning Score 2 (NEWS2)
Read information from the Royal College of Physicians (RCP) National Early Warning Score 2 (NEWS2) system which has been developed to improve detection and response to clinical deterioration in adult patients. The system has not specifically been designed for the COVID 19 outbreak but is a vital tool to support clinical judgement with the emergency situations.
We need to be aware that people may experience considerable stress during this outbreak and be in closer contact with household members for longer periods of time, which may increase issues related to safeguarding.
Children
- RCPCH: COVID-19 - guidance for paediatric services. Further advice and guidance will be added should further information become available
- RCPCH: Advice for parents during coronavirus
- RCPCH: Looked After Children services in COVID-19 pandemic recovery plans - statement. See also: Paediatricians working in the community, and COVID-19 - guidance for paediatric services - occupational health
See also:
- Department for Education: Coronavirus (COVID-19): guidance for children's social care services
- Home Office: Countering online child sexual exploitation and abuse during the coronavirus (COVID-19) pandemic
With infants and young children spending more time indoors it is important that we all remind parents of potential hazards in the home, including hazards such as blind cords. There have been one or two deaths recently of young infants/children getting tied up in blind cords. Info can be found at CAPT and NHS advice for new parents.
Adults
Changes in patterns of day to day life may result increased safeguarding events as people spend longer periods of time together without access to recreational activities and other opportunities to socialise, Community nurses need to be aware that they may be an increase in abuse, harm or neglect and understand their role for both adults and any children that may be involved.
Many of the usual options for respite care, such as day centres and home support, may not be available during this COVID-19 outbreak. This is likely to increase the stresses placed on family carers. Additionally, people with high levels of need may be exposed to unscrupulous persons who may contact them offering services or financial advice which may result in abuse. We recognise that community nurses will often be the only people who are entering the homes of many adults with high level of care need and will demonstrate their usual vigilance to identify safeguarding concerns. It is important you are familiar with any different ways of working in your locality in order to protect people.
See also:
Commission for Countering Extremism: COVID-19: How hateful extremists are exploiting the pandemic
Domestic abuse and COVID-19
The coronavirus (COVID-19) outbreak has resulted in major implications for health and care services in the UK, and for health and care staff. This briefing is to support members making difficult decisions during this challenging time.
Background
Health and social care staff are faced with difficult decisions every day. However, planning for and responding to COVID-19 will require nurses and members of the nursing team to make difficult decisions under new and exceptional pressures, with limited time, resources and information.
These decisions could relate to the care we provide, how we provide it and who we can provide it to and could have wider impacts on the delivery of our health and social care services.
RCN Position
Making these difficult decisions should be based on our professional judgement, in accordance with the law, relevant guidance and evidence, and statutory duties.
This resource is designed to direct RCN members to the relevant resources designed to support specific areas of care but also provide some overarching principles.
It is critical that our decisions are made with transparency and are free from unlawful discrimination and personal bias, commensurate with the spirit of the Human Rights Act 1998 and Equality provisions operating across the UK.
- The right to life must be preserved wherever possible
- The protected characteristics of a patient such as their age, ethnicity, gender, sexual orientation, should not influence our clinical decision making without a clear evidence base for doing so.
- Decisions must be taken in consultation and discussion with the patient during this pandemic, wherever possible.
- Health and care workers must be supported including with relevant and adequate guidance and resources, in order to provide the best possible care in the context of this emergency.
Guidance
Wherever possible decisions must be taken in consultation and discussion with the patient. If treatment is available (subject to resources), and there is a real prospect that the patient would benefit, then the treatment should be offered.
A patient with capacity should be given sufficient information to make a real choice of which available treatment, if any, to consent to. If the patient lacks capacity, then the clinician should decide which, if any, available treatment is in the best interests of the patient, but should normally consult with the patient’s family and carers, or an independent mental capacity advocate (if appropriate), before making this decision.
A record of the decision and the discussion should be made.
If a treatment is likely to be futile, or harmful, then it need not be offered. For example, if there is no real prospect that mechanical ventilation will benefit the patient, then it should not be offered. The clinician should explain to the patient why it would not be appropriate. Ultimately, the patient does not have the right to insist on a treatment that would not be beneficial.
Resources to Support Practice
For more information about this visit:
- RCN COVID-19 guidance on DNACPR and verification of death
- RCN Unsustainable pressures. Resources to support RCN members dealing with unsustainable service pressures
- Resuscitation Council UK 2021 Resuscitation Guidelines: Ethics Guidelines
- Joint NMC/RCN statement regarding Decisions Relating to Cardiopulmonary Resuscitation (CPR) (updated March 2020)
- RCP joint statement on ethical guidance for front line staff
- Equality and Human Rights Commission
- Equality Commission
- Northern Ireland Human Rights Commission
With recognition of the increasing pressures and demand on staff and on the health and care system, it might become necessary to make challenging decisions about how to direct resources to where they are needed most, and to prioritise individual care needs.
The NICE Coronavirus (COVID-19) rapid guidelines and evidence summaries, include a decision tree algorithm and tools to support clinical decision making:
See also The Joint statement on developing immediate critical care nursing capacity
The Ethical guidance: Department of Health and Social Care Adult Social Care Ethical Framework; provides support for ongoing response planning and decision-making to ensure that sufficient consideration is given to ethical values and principles when organising and delivering social care for adults.
The framework intends to serve as a guide for these types of decisions, and that consideration of any potential harm that might be suffered and the needs of all individuals are central to decision-making.
Due to coronavirus infection (COVID-19) there will be an increase in numbers of people with Palliative and end of life care needs. This will include those who have also become palliative during the pandemic with COVID-19 and also unrelated conditions and be impacted by changes to health and care services in this time of unprecedented demand. This briefing is to support members at a time of unprecedented numbers of deaths due to COVID-19.
Background
Palliative care is the care people receive when their treatment is no longer considered curative. The Palliative care philosophy promotes holistic care looking after all the domains in life that makes us individual and important to ourselves and those around us. It is recognised that for some people, curative interventions for COVID-19 may be inappropriate and/or ineffective and a palliative approach to care may be implemented.
Palliative and end of life care is delivered by a range of healthcare professionals across the health and social care workforce. Community nursing caseloads will have a large proportion of people who have palliative and end of life care needs, and this is likely to increase. Palliative may need to be given in settings which do not normally care for people at the end of life.
People with current palliative care needs may fall within the vulnerable group criteria and should they contract COVID-19 they may find that they decline more rapidly than would have been expected. Advance care planning is critical to ensuring that people who are or who may become palliative during this pandemic have opportunity to discuss their wishes.
Conversations with people who are approaching the end of their life are not always easy, but they are necessary. Opportunities to discuss Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) with the person or their advocate/family if they lack capacity, are important and should be initiated as early on within the illness as possible. Advance Care plans including advance directives to refuse treatment should be discussed and support put in place to complete, should the person decide that this is what is important to them.
Where a person lacks capacity then a decision in their best interests (a best interests decision implies a formal legal decision under MCA) should always be made supported by the people that know them the best. Or who have powers of attorney
As a result of COVID 19, life expectancy may be shorter than previously expected and people and their families should, as far as possible, be prepared for this. Sensitivity and kindness must prevail even in these challenging situations.
Hospices and specialist palliative care providers may change the way they are working during this pandemic.
Guidance
Dignity, respect and compassion must remain at the core of the delivery of end of life care.
People approaching the end of their lives should still be engaged in conversations about their treatment during this pandemic, wherever possible. This may form a part of advanced decision-making conversations. See section on DNACPR and advanced decision making
As far as reasonably possible, people’s cultural and religious beliefs should be explored and respected. However, as the pandemic increases, this may not always be possible.
Health and care workers in all relevant settings must be supported including with relevant and adequate guidance and resources, in order to provide the best possible end of life care in the context of this emergency.
Resources to support practice
Further protocols and guidance are currently being produced to support care of the dying in the community, and in mental health. This will be added to this resource as they become available.
- RCN: Guidance on advance care planning
- RCN: COVID-19 guidance on DNACPR and verification of death
- RCN: Having courageous conversations by telephone or video during the COVID-19 pandemic
- All Wales Therapeutics & Toxicity Centre. End of Life COVID-19 Medicines Service to supply Just in Time Emergency Medicine Packs.
- APM: COVID-19 and Palliative, End of Life and Bereavement Care in Secondary Care
- Department of Health and Social Care: Coronavirus (COVID-19): looking after people who lack mental capacity
- COVID EoLC Community Charter
- e-Learning for Healthcare: End of Life Care for All
- Hospice UK: Coronavirus Guidance (COVID-19)
- Hospice UK: Caring for your dying relative at home with COVID-19
- Hospice UK: Special Edition of Care After Death: Registered Nurse Verification of Expected Adult Death (RNVoEAD) guidance
- Hospice UK: Care After Death: Guidance for staff responsible for care after death (third edition)
- Marie Curie: Coronavirus (COVID-19) if you’re affected by terminal illness
- National Bereavement Alliance: Keeping in touch when someone is seriously ill
- NHS England: Clinical guide for the management of palliative care in hospital during the coronavirus pandemic
- NHS England: Palliative care speciality guides
- NHS England: Visiting healthcare inpatient settings during the COVID-19 pandemic
- Public Health England: COVID-19: guidance for care of the deceased
- RCGP: Community Palliative, End of Life and Bereavement Care in the COVID-19 pandemic
- RCGP: End of life and palliative care toolkit
- RCGP: End of life quality improvement resources
- Social Care Wales: Supporting end of life care in social care settings during COVID-19.
- Welsh Government. Reuse of end of life medicines in hospices and care homes during COVID-19.
Bereavement Support
It is likely that people who may become bereaved during this time may need extra bereavement care and support, local hospice websites may have local information.
You can also access information here.
National Early Warning Score 2 (NEWS2)
Read information from the Royal College of Physicians (RCP) National Early Warning Score 2 (NEWS2) system which has been developed to improve detection and response to clinical deterioration in adult patients. The system has not specifically been designed for the COVID 19 outbreak but is a vital tool to support clinical judgement with the emergency situations.
It is likely that people who may become bereaved during this time may need extra bereavement care and support, local hospice websites may have local information. See: Coronavirus: dealing with bereavement and grief.
Nursing teams work closely with many community and staff groups. Set out below are the links to guidance covering different sectors that may be helpful to you in managing day to day interaction with colleagues and will inform your own practice.
Care home providers should stop visits to residents from friends and family. Healthcare professionals and delivery couriers can still visit.
RCN
- COVID-19 Care home visiting position statement. A statement of the RCN position on enabling visiting in care homes (nursing) for older people using an individual dynamic risk assessment
- COVID-19 Care home visiting FAQs. FAQs for older peoples care home (nursing) visiting
England
- Department of Health and Social Care: Coronavirus (COVID-19): looking after people who lack mental capacity
- Department of Health and Social Care: New guidance to support safe care home visits during lockdown
- Department of Health and Social Care: Coronavirus (COVID-19): admission and care of people in care homes
- Department of Health and Social Care: PHE & NHS England, Admission and care of residents during COVID-19 incident in a care home
- Department of Health and Social Care: Health and wellbeing of the adult social care workforce
- Department of Health and Social Care: Coronavirus (COVID-19): adult social care action plan
- Department of Health and Social Care, Public Health England, Care Quality Commission, and NHS England: Designated settings for people discharged to a care home
- HEE:COVID-19 Resources for Health and Care Staff in Care Home Settings
- Hospice UK: Caring for your dying relative at home with COVID-19
- NHS England & NHS Improvement: Clinical guide for the management of palliative care in hospital during the coronavirus pandemic
- PHE: COVID-19: ethical framework for adult social care
- PHE: COVID-19: changes to the Care Act 2014
- PHE: COVID-19: how to work safely in care homes
Also available from PHE is a video guide to putting and removing Personal Protective Equipment (PPE) and two posters for care homes showing how to put on PPE and how to take it off safely.
COVID-19: guidance on residential care provision:
- Department of Health and Social Care: Visiting care homes during coronavirus
- GOV.UK: Ethical Framework
- SCIE: Care homes and COVID-19: advice and best practice
Scotland
Scottish Government guidelines:
- COVID-19 - information and guidance for social or community care & residential settings and letter from the Chief Medical Officer, Chief Nursing Officer and Chief Social Worker. Care home new admissions or transfer form and clinical guidance on COVID-19 for the management of clients accessing care at home, housing support and sheltered housing.
- Coronavirus (COVID-19): clinical and practice guidance for adult care homes
SCIE: Dementia in care homes and COVID-19
Northern Ireland
- HSC Public Health Agency: COVID-19 (coronavirus)
Wales
- Social Care Wales: The latest information on coronavirus (COVID-19)
National Early Warning Score 2 (NEWS2)
Read information from the Royal College of Physicians (RCP) National Early Warning Score 2 (NEWS2) system which has been developed to improve detection and response to clinical deterioration in adult patients. The system has not specifically been designed for the COVID 19 outbreak but is a vital tool to support clinical judgement with the emergency situations.
British Geriatrics Society. COVID-19: Managing the COVID-19 pandemic in care homes for older people. The COVID-19 pandemic raises particular challenges for care home residents, their families and the staff that look after them. This guidance has been developed to help care home staff and NHS staff who work with them to support residents through the pandemic.
- European Centre for Disease Prevention and Control (ECDC): COVID-19
- PHE: COVID-19: stay at home guidance
- Scottish Council for Voluntary Organisations: COVID-19 Third Sector Information Hub
- Scottish Social Service Council: Guidance to help social workers respond to COVID-19 (coronavirus)
- Scottish Government: Coronavirus social care guidance including Clinical Guidance for Nursing Home and Residential Care Residents
- RCN: COVID-19 (coronavirus)
- World Health Organization (WHO): Novel Coronavirus (2019-nCoV) advice for the public
- Public Health England. How to stop the spread of COVID-19 (available in 30 languages)
- Doctors of the World: Coronavirus (Covid-19) advice for patients in 21 languages
- NHS Inform: Advice in British Sign Language
- NHS Inform: Advice in Easy Read
- Groundswell: COVID leaflets for rough sleepers and people in hostels
- Asylum Project Appeals Project: Leaflet regarding asylum support
- Action on Hearing Loss. Communication tips for health and social care professionals.
Page last updated - 31/08/2022