Abstract

Background: The COVID-19 pandemic challenged the provision of social and nursing care in the community in numerous ways. This included the introduction and constant adaptation of infection control measures, care for people with COVID-19, educating patients and carers and upholding continuity and comprehensiveness of services available. However, guidance that was tailored to the community setting was lacking in Germany, leading to increased strain on clinicians and mangers and potentially problematic patient outcomes.

Objectives: To provide guidance for nurses and providers of community care, a structured clinical guideline was developed under the auspices of the German Society of Nursing Science.

Methods: Guideline development followed the rule book of the Association of the Scientific Medical Societies in Germany (AWMF) which aligns with the AGREE II criteria for the appraisal of clinical guidelines. Representatives from nursing, family medicine, public health, gerontology, care providers and health insurances as well as patient representatives collaborated on the project and a steering group commenced work in May 2020. Key questions were identified, and a systematic review of the international literature carried out. Recommendations were drafted by the steering group, reviewed with all delegates, and endorsed by all organisations involved. A first version of the guideline was published in December 2020 and updated in April 2021. A further updated and upgraded version, including a formal consensus process for recommendations, was published in June 2022. No funding was received for the guideline development

Results: The latest version of the guideline (AWMF registry No 184-002) includes four recommendations on preparations for a pandemic outbreak, nine on infection protection, six on care for persons with COVID-19, three on social inclusion and quality of life, two on investigations when a SARS-CoV-2 infection is suspected, eight on supporting families and carers and seven on interprofessional collaboration. A condensed, easy to understand user version of the guideline was also developed.

Guideline development was challenged by a lack of good quality evidence, the evolution of the pandemic as well as quickly changing federal, state and local infection control regulations. Recommendations are informed by the limited evidence available but mainly based on expert opinion.

Recommendations had to make adjustments for the limited scope of services in the community covered by the German statutory long-term care insurance and health insurance. Especially patient and carer education are severely hindered by a lack of reimbursement.

Conclusions: The guideline brings together the available evidence and expert recommendations for nurses in the community and long-term community care providers. It was accepted well by the intended recipients; however, concerns were raised about the lack of adequate reimbursement for services and interventions recommended. This indicates a need for reform in how the long-term care system is configured.

Some recommendations outdated quickly and more frequent updates as a "living guideline" would be desirable. However, the limited evidence base and lack of funding impeded guideline development. The guideline may be further developed as a tool to prepare for future pandemics or possible other health crisis.

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