Nurses are leading the management of care in our communities, and Covid-19 has drawn into sharp focus their impact on community health engagement and in particular, the needs of vulnerable populations.
“Nurses see their communities with 360-degree vision. We see the client, the environment they are in, and can coordinate an optimal response based on our knowledge,” says Vanessa Wright, an adjunct professor at the Lawrence Bloomberg Faculty of Nursing.
Wright is also a Nurse Practitioner at Women’s College Hospital and has been involved in testing and outbreak management at shelters throughout the pandemic. Her ten years of experience working in refugee clinics providing onsite clinical expertise, health promotion and helping clients navigate the health care system, has also given her some insights.
“The first principle of community engagement is going to the people,” says Wright “we strive to become that consistent provider of care, become that familiar face, to ensure we build a relationship of trust.”
On May 11, Wright along with Nurse Practitioners and fellow faculty members Joanne Louis and Jean Wilson will be leading a panel to discuss the impact of that trust on community health as part of the Faculty of Nursing’s National Nursing Week Celebrations.
For Wright, in her current line of work providing vaccines to shelter populations, trust and engagement is everything. Those living in shelter settings are at a much higher risk of contracting Covid-19 and many do not have ID or documentation which is often required at other city-run clinics, or access to a computer to book appointments.
“Getting the vaccines organized is the easy part,” says Wright “the challenge is finding ways to support and prepare our clients to receive the vaccine, many of whom have well-founded concerns and a distrust of the health care system. This means that we as care providers, need to recognize the uniqueness of each patient encounter and tailor our care response accordingly.”
That tailored approach can mean the difference between hosting a webinar or providing culturally and language appropriate materials or going and talking to people one on one. At the moment, Wright and her team are busier than ever in what she describes as a race against time and against variants, as they aim to provide vaccines in a safe, equitable, community centered way while still staying on top of testing.
“Things are far from stable,” Wright says, “but that time we have taken to engage the community is showing its benefits.”
Alongside homeless and shelter populations, those who are refugees or migrants in the city also face barriers when needing access to care including vaccines. Finding ways to eliminate those barriers is another way in which nurses like Joanne Louis are helping to bring the care to the community.
“We try to give people a pathway to care,” says Louis, who is also an assistant professor at the Lawrence Bloomberg Faculty of Nursing. “For uninsured populations who are eligible to access care, we help to ensure that not only are they able to access it, but that it is also sustainable.”
Louis explains that while volunteer clinics exist to support the non-insured, this patchwork network is not the same as sustainable primary care. Advocacy work, to have the different levels of government recognize that these populations exist, is also integral especially in relation to Covid-19 and access to vaccines.
“Getting a health card doesn’t mean there is equitable access to care for these populations,” explains Louis, “many of these individuals are also essential workers, what does that mean for them in terms of vaccine access?”
Louis’ interest in the health of migrant populations stems from her time as a street nurse. Many of the people she encounters do not have access to appropriate health care, due to addiction or other health issues, and without documentation, they are denied access though they are eligible to receive care.
“As a nurse, we are their first point of care, but part of our role is case management and that means looking beyond acute, episodic care and seeing the larger picture,” says Louis.
That pivotal role nurses play in transitioning between primary and public health can also be integral to outbreak investigations and management in the community.
Jean Wilson, who is also an assistant professor at the Lawrence Bloomberg Faculty of Nursing, began her career as a nurse working in remote fly-in communities in the North where nurses were responsible for delivering both primary and public health care to many Indigenous communities.
“As a primary care provider, you see how public health impacts a population at an individual level, whether it is a communicable or chronic disease,” says Wilson. “Having that big picture focus for what I was treating in the community made a huge difference in how I approached patients for health promotion and prevention.”
Wilson has also worked on outbreak surveillance and investigations in Canada on behalf of the Public Health Agency of Canada, and with the Canadian Armed Forces in Bosnia just after 9/11 when bioterrorism was considered a significant threat. Her experience in the zoonotic division, managing and understanding outbreaks that arise from animal to human transmission, has prepared her immensely for helping communities impacted by Covid-19.
“A lot of our prevention work centers around an understanding of immunizations, herd immunity and mass vaccination programs,” says Wilson. “It is important that nurse practitioners use this as a tool to educate communities and health care workers as we aim to reduce vaccine hesitancy.”
Wilson developed an educational module as part of the pathophysiology and pharmacology course she teaches that discusses the types of vaccines being used to protect against Covid-19 including those that use mRNA. Describing the pros and cons of each vaccine, Wilson’s course empowers nurse practitioners entering the field to be better able to communicate with patients around vaccine hesitancy.
“Empowering our nurses with knowledge helps them alleviate a lot of anxiety around vaccines, particularly in Indigenous or marginalized communities who have a lived experience that rightly so, make them concerned,” says Wilson.
As National Nursing Week draws near, nurses should be recognized for their ability and leadership when it comes to caring for communities most in need.
“Nurses need to recognize the potential value that is added in terms of working in acute care environments,” says Wright. “Even those who work in hospitals are supporting communities, the work we do is influential. We are public health ambassadors in a time of great need.”
National Nursing Week is being celebrated May 10-16, 2021, visit the Lawrence Bloomberg website for details on U of T’s celebrations.