COVID-19 tests: what HIV nursing can teach us about the importance of pastoral care
When someone tests positive for coronavirus, they need support to come to terms with what it means for their lives
I work on a drive-through pre-op COVID-19 swab nursing team at a district general hospital.
We see between 25 and 40 patients each day for their test, 72 hours before admission for their surgical procedure.
Although the service started in July, it wasn't until September we had our first COVID-19 positive result. Since then, we have had a further six positive results.
This in a population of people coming for surgery, who are asymptomatic, often with pre-existing health problems and shielding or self-isolating.
The role of pre-test counselling in preparing the individual
As I gave my first positive COVID-19 result, I was reminded of my years working as an HIV specialist nurse and of the many hundreds of HIV-positive results I gave while working in a city centre sexual health clinic.
When we tested patients for HIV, we always provided pre-test counselling.
This gave us an opportunity to discuss what a positive result would mean to them.
This would often be related to what patients’ understanding of HIV was, who they knew who had already been diagnosed and how their health had been affected by the condition.
A positive result can feel life-changing and is likely to induce anxiety
When I give a positive COVID-19 result I know none of this information, so I tread carefully.
The person I'm speaking to will now have their surgery postponed, and be worrying about the impact of that. They may also be frightened about how COVID-19 might affect them.
This fear may be heightened if they are from a black, Asian or minority ethnic group or have other health conditions and are at higher risk.
Patients may have experienced loss already due to COVID-19 and, like many of us, become isolated from extended family, friends and colleagues.
Contact tracing brings with it complex considerations
Then there is the issue of contact tracing; something I had a lot of experience with while supporting HIV-positive patients.
Informing your family, friends and colleagues that you may have passed on an infection is a daunting task, even though one of those people may be the source of infection.
These people are the ones we care about most so there is fear for their health and the consequences of infection.
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Every individual must take responsibility for their own health, but we do need to encourage newly diagnosed patients to notify their contacts so they can be tested and isolate. Then we can break the cycle of infection.
With HIV-positive patients, we would support them in this process by offering to notify their contacts for them, often doing so while maintaining their anonymity.
Back then, people feared an HIV diagnosis might wreck their relationship, lead them to lose their job or home, or increase their risk of domestic violence.
A diagnosis wouldn't be something to share with just anyone, unless they were trusted – it wasn't something to tell the neighbours.
Could the same be said of patients being diagnosed with COVID-19?
There’s little scope for mental heath support when results are sent by text
There is also the mental health impact.
The saddest people I ever met were mothers whose children contracted HIV at birth, in the days before we routinely screened antenatally and didn't know how to prevent vertical transmission.
‘Giving a positive COVID-19 result isn't straightforward and shouldn't be considered so. It needs consideration and the staff breaking results need support to do it well’
Imagine how someone might feel now testing positive for COVID-19 and realising their partner, children and parents have also been put at risk?
What support is there for these patients?
The NHS Track and Trace service is being run by outsourced staff and most people receive their COVID-19 test results by text or email.
Information and support help the person come to terms with their positive test result
The context to an HIV diagnosis was crucial: care, information and support offered in that initial period affected how a person dealt with the news.
For patients to come to terms with a diagnosis – and not be made to feel dirty, ashamed or at fault and to be confident in contact tracing – they were dependant on this initial experience.
I've already heard people say that they wouldn't want to know if they had COVID-19, and that they don't want to sign up for track and trace because they don't want to be blamed.
People have told me that a diagnosis might mean they can't work and they can't afford to take time off.
Giving and receiving a coronavirus test result is complicated
Giving a positive COVID-19 result isn’t straightforward and shouldn’t be considered so.
It needs care and consideration and the staff breaking results need support and supervision to make sure they do it well.
In the 1990s, I was a member of the National HIV Nurses Association, which was a place to share and support nurses looking after HIV-positive patients.
Being part of this group gave me the knowledge and skills to do my HIV nursing job to my best ability.
It was a place to share and support any nurses across the country looking after HIV-positive patients.
I think it’s time for a national COVID-19 nurses association. Are you with me?
