Journal of Community Nursing

66 JCN 2020,Vol 34, No 4 T he current Covid-19 pandemic has been responsible for a profound change in the way that the Parkinson’s disease nurse specialist (PDNS) is able to offer support and advice for people with Parkinson’s disease (PwP). Historically PwP have relied on the availability of both scheduled and unscheduled contact with their PDNS in the primary or secondary care setting to optimise their management plan (National Institute for Health and Care Excellence [NICE], 2017). These assessments and reviews remain as pertinent as ever, even though face-to-face contact is to be avoided wherever possible in the current climate. The UK government statement identified PwP as being in the vulnerable group, although there Caring for patients with Parkinson’s disease during the Covid-19 pandemic was no differentiation specified across the disease trajectory from diagnosis through to the more complex stages (GOV UK, 2020). This has resulted in some confusion for PwP regarding whether or not they should be strictly self-isolating. It is suggested that this needs to be addressed on an individual basis, considering factors such as age, stage and any other comorbidities (Association of British Neurologists, 2020). The current restrictions have resulted in a rapid move to predominantly delivering services remotely via telephone or video consultations. While this has been essential during the restrictions, in the authors’ clinical opinion, this approach could result in a loss of non-verbal cues from the PwP or their partner that add another perspective to the face-to- face consultation. Parkinson’s disease (PD) is a chronic and progressive neurological condition of unknown cause, resulting from a loss of dopamine producing cells (Clarke, 2007). The most recognisable features of this condition, that affects over 145,000 people in the United Kingdom (UK), are associated with motor symptoms such as rigidity, tremor and bradykinesia (Parkinson’s UK, 2017). It is increasingly evident that non-motor symptoms can be most troublesome to PwP and have a great impact on their quality of life (Chaudhuri and Fung, 2016). A common and challenging non- motor feature is anxiety, which is of particular relevance during the Covid-19 pandemic, due to many people already having a heightened state of anxiety (Helmich and Bloem, 2020). It is therefore understandable that for PwP their level of anxiety could be exacerbated and significantly impact on their daily life, which could adversely affect their PD symptom control. Tremor is a motor symptom which can be affected by anxiety, often becoming more pronounced (Heusinkveld et al, 2018). PwP and their partners may consider the increased tremor to be a sign of progression of their PD, and providing them with the opportunity to discuss such concerns in a timely manner, may be all that is required to reassure them. However, an important aspect of the PDNS role is to interpret the findings from any remote assessment to determine if there is any indication that there has been a change in symptom control that might benefit from a change to the treatment plan, and this is when video consultation could be particularly useful. In the authors’clinical experience, timely interaction with the PDNS could reduce the risk of individuals needing to access other support externally, which might not only avoid treatment decisions being made out of the usual context, but also alleviate increasing pressure on the National Health Service (NHS). Jane Price, Parkinson’s disease nurse advanced practitioner, Powys Teaching Health Board; Hannah Martin, advanced nurse practitioner Parkinson’s disease, University Hospitals Coventry and Warwickshire NHS Trust; Louise Ebenezer, Parkinson’s disease nurse specialist, Cwm Taf Morgannwg University Health Board It is estimated that there are currently over 145,000 people diagnosed with Parkinson’s disease in the UK. This progressive neurological condition affects people in a variety of ways, depending on numerous factors, including the impact and severity of their motor and non-motor symptoms. In relation to the current Covid-19 pandemic, the UK government identified people with Parkinson’s disease as clinically vulnerable, suggesting that they were at higher risk of severe illness if they contracted the Covid-19 virus. The subsequent self-imposed isolation could potentially impact on Parkinson’s symptom control, and also affect wellbeing and quality of life. The Parkinson’s disease nurse specialist has had to rapidly adapt service delivery to ensure that the needs of people with Parkinson’s disease are addressed, predominantly with remote assessment, during the Covid-19 pandemic. KEYWORDS:  Parkinson’s disease  Covid-19 pandemic  Self-isolation  Remote consultation Jane Price, Hannah Martin, Louise Ebenezer PARKINSON’S DISEASE