Experts at the University of Toronto say COVID-19 has drawn into sharp focus the impact that nurses have on community health engagement – and the needs of vulnerable populations.
“Nurses see their communities with 360-degree vision. We see the client, the environment they are in, and can co-ordinate an optimal response based on our knowledge,” says Vanessa Wright, an adjunct professor at the Lawrence S. Bloomberg Faculty of Nursing.
A nurse practitioner at Women’s College Hospital, Wright has been involved in testing and outbreak management at shelters throughout the pandemic. She has 10 years of experience working in refugee clinics providing onsite clinical expertise, health promotion and helping clients navigate the health-care system.
“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 and fellow nurse practitioners and U of T 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.
Wright, who provides vaccines to shelter populations, says trust and engagement are 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 could involve hosting a webinar, providing culturally appropriate and language appropriate materials or talking to people one-on-one. These days, 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-centred 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 people experiencing homelessness 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 a focus for Louis, an assistant professor, teaching stream, at the Lawrence S. Bloomberg Faculty of Nursing.
“We try to give people a pathway to care,” says Louis. “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.”
Volunteer clinics support the non-insured but this patchwork network is not the same as sustainable primary care, Louis says. She adds that advocacy to have the different levels of government recognize that these populations exist is particularly important 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,” Louis says. “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.”
That pivotal role nurses play in transitioning between primary and public health can also be integral to outbreak investigations and management in the community.
Wilson, who is also an assistant professor, teaching stream, at the Lawrence S. 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 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, prepared her for helping communities affected by COVID-19.
“A lot of our prevention work centres 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 for the pathophysiology and pharmacology course she teaches to help nurse practitioners entering the field better 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, Wright says it’s important to recognize the value they add in the community and in acute care environments.
“We are public health ambassadors in a time of great need.”