We’re so proud of our frontline staff at St Andrew’s Hospice who have committed themselves to their caring profession and worked on the ward tirelessly throughout recent events. Now things are beginning to ease a little we’ve managed to sit down with the lovely Amie Carlton - one of our Clinical Leads on the Adult’s unit - to discuss the challenges, but also the opportunities the outbreak created, and her unwavering passion for the job.
I’ve worked at St Andrew’s Hospice for three and a half years and it’s my sixth year of being a qualified nurse. I began here as a trained nurse for 18 months and then was promoted to a clinical lead post. I’m really enjoying it: it’s the best move I’ve ever made. St Andrew’s Hospice was definitely somewhere I wanted to be anyway when I was looking at my options during qualifying, but I just needed to get some background knowledge and experience together – get all my armour together so to speak!
Really it was the reputation of the hospice that made me aspire to work here more than anything. I knew that hospice care is the ultimate that we can give to our patients, and I wanted to work more in end of life as it was something that has interested me for a long time. I had to dip in and out of palliative work within the ward environments I’ve been in before, but it was definitely something I’ve always wanted to do full-time.
It can be quite difficult day-to-day at times, but we have a really good team and we really support each other. I wouldn’t say end of life is something that really affects me, the job is just something that is in you. My mum is a nurse too and she always dreamt about working in the hospice, so it has always been talked about growing up.
When I’m working on the unit my general nursing care tasks include administering medications when I come on shift and giving handover when I leave. We ensure to keep all documentation up to date and highlight anything that is incorrect. As a nurse at the hospice our hands on care is basically the same as what other carers do. If I was working in a hospital, my role would be lot more management focused and hands off.
We’re fundamentally here to support patients, checking their skin and symptoms for instance. The clinical lead job role consists of a two-week rolling rota: two weeks on the unit, and two weeks clinical lead on shift. This includes five days in the office doing tasks such as discharge planning, chasing up funding for fast-tracks, anything to do with families, future care planning and preferred place of death. When updating patients and their families on their progress there are some quite difficult questions we have to ask and hard conversations we have to have.
I will go out and assess patients as well if we get a referral for respite symptom management and there is no known connection to the Macmillan or Haven services. Although, we haven’t been doing many home visits during the pandemic.
I also manage a group of six staff whom I do one-to-ones with as well as c and ds. I’m personally involved in improving things in the wider hospice too: reviewing care plans, policies and procedures. The list is endless...Oh and the off duty!
My favourite thing about the hospice is being involved in the actual care, looking after the patients and making sure that you can make everything as nice as you possibly can for someone who is dying. Everyone is often on the same page, and more recently we’ve been able to offer patients and families the whole package including making the memories. The wellbeing coordinators have taught and some of the nurses including myself how to do this. We’ve started with fingerprint bookmarks and enjoy doing it.
The conversations we can have with families whilst we are doing something so personal like memory work is priceless as you’re getting extra time with them. The things that come out in conversation during the session we might not have ever been able to have discuss or and certain feelings may not have been prompted. I think this is because during these sessions everyone is focused on doing something concentrated on patient like taking finger instead of purely focused on sitting there having an informal conversation. It opens up an avenue of being able to communicate differently, as in these instances patients and families don’t have to look at who they are speaking to directly if the conversation becomes difficult.
The first time I did memory work with a patient I nearly cried as it was so emotional knowing that person wasn’t going to be there much longer, and that was the only physical thing the family were going to have left. They will have memories and possessions, but a fingerprint is literally individual and is gone once someone has died.
Sometimes people don’t want to participate in memory work and of course that’s fine. But older people don’t always get such work offered to them despite having still lived a life and also leaving people behind. So, it has been brilliant being able to offer the activities to them recently. It is also low cost and very effective. A touching example of this is the session I undertook with a male palliative patient. He had only been in two days at this point and the memory work involved creating the owls on a tree branch. Owls turned out to be quite a significant subject for him and his family, and his wife framed the piece with the plan to gift it to their children at Christmas after their father has passed away. That was rather emotional for me.
The Family support ladies have helped us a lot with these activities. The work is very popular, and you can see why – you can do it at any stage in someone’s life: when they’re poorly or even when they’re well! It has made me want to create some pieces my family and I. It’s just so lovely.
My job has definitely been a lot more stressful since the Covid outbreak. It has been a very difficult period and there’s been a lot of changes that have been implemented quickly. I think the hardest thing for me and probably the other staff on ward has been having to restrict people visiting patients. During lockdown we had to limit visitors to two designated people per patient. How do you decide which two of your six children you’d prefer to visit you? You can’t. Choosing between family members can also mean rifts are opened. This is the last thing anybody wants when their loved one is dying. We’ve had to sign each visitor in and take their temperatures, which added to our workload. Restrictions were lightened a little bit when a patient was imminently about to die. However, although we work with people who are dying day-in day-out, it’s tricky to predict when exactly the death is going to be, we just know it will be in the next few days. It’s been much easier since visiting has opened up to two visitors at any one time.
Wearing masks has been horrible. Twelve hours in a mask is hard going! It has been hot! At first wearing a mask meant my glasses often steamed up and I couldn’t see, but we’ve been sharing tips amongst the clinical team to prevent this. We also wear visors on top of the masks. It isn’t nice for the patients and has really contributed to a breakdown in conversation with them, especially for those that have a hearing impairment. A lot of people who are deaf tend to lip read, but masks prevent people being able to do this or even read our expressions. It’s particularly hard when we are trying to have the difficult conversations with our patients that they may not have ever had before with anyone.
Patients have been extremely patient and understanding of the situation. All off the relatives have been sticking to the rules in the main, but there are the odd ones that don’t want to wear masks. Obviously, it’s quite hard for them as they’ve come in to see their ill family members and they have a lot on their mind. But we don’t know when the pandemic is going to settle down, so we’re going to have to live with the masks indefinitely. It’s easier now we have routines in place: it was hard in the beginning!
Touching, or the lack of, has been a difficult thing as well. You want to hug someone when they’re going through one of the hardest times of their life which we can’t do at present. This means our care becomes a bit more impersonal. I describe coming here as “the hospice hug”. Some patients turn up not very well at all: they’ve been in hospital a long time and they’re tired, then and we give them a “hospice hug”. They come in, have a bit of time and space in a quiet environment, we provide them with the care they need, and then they pick up. We see that quite a lot here. But again, we can’t do that quite as much at the moment.
Everybody is so warm and inviting here. I’m sure other places have good qualities as well, but there’s just something comforting you feel when you come here. A lovely feeling.
Staffing has been an issue for us during the pandemic as people have had to take time-off and self-isolate due to being in a group that is particularly at risk. We’ve had to rely heavily on Bank staff. Recruiting is difficult as we can’t have face to face interviews and the whole process takes longer. But my Mum also works here and starts back tomorrow which is positive news!
We’re good with rolling with the punches at St Andrew’s, being in an environment where we don’t know what is coming day-to-day, which is why I think we’ve been so good at adapting. It’ll be nice to start seeing more people in the hospice again. Before people would come and go freely and we’d see a lot of people in hub.
The coming together of the staff during this time has made us stronger than ever. We knew we were a robust team before, but there’s been so many changes and we’ve had to work together to acclimatise. It has certainly proven just how good we are as a team!
Karen stepping into her new role as Director of Adult Services has helped massively with continuity. To have someone with a senior management point of view, who has regular direct contact with the wider team upstairs has been a lot better and we’ve received information much quicker. We now have a way to offload our concerns, and changes required or requests for equipment is acted on quickly.
Another thing that we’ve benefited from due to the Corona Virus is the increased use of technology. For example, one of our doctors couldn’t be in for her shift but was able to undertake a bedside consultation using the unit’s iPad. It has also meant that patients have been able to make contact with family that haven’t been able to visit. The first video call I aided a patient with was with his son who resides in Australia. This provided some comfort to one another. The patient passed away the following day, so it was nice that father and son could talk one last time.
The pandemic has made us review all our processes like virtual communication and this has allowed us to give that additional extra bit, that is what we always want to do anyway. Providing those special touches is what we’re all about here at St Andrew’s Hospice. It isn’t like a hospital environment: we’re able to do much more, which is why I love it! I love my job - you will have to prise me away from this place!
We as a planet didn’t know enough about the corona virus at the beginning of the outbreak so everyone has been trying and adapting the best they can. We’ve only had one Covid-19 positive patient at the hospice and that was a few months ago in April/ May. They were already end of life and had unfortunately also caught the virus prior to coming into the hospice.
I allocated myself as the one going in and out of the patient’s room and worked continuously with her throughout her stay. We had to enforce total isolation. She did deteriorate, so at that point we allowed the family to come in to say their goodbyes. But they had to enter a different way to the visitors of other patients, and wear gowns, masks and scrubs. It wasn’t nice to have to limit the patient’s contact with their relatives in this way. I really feel for the relatives having not been able to have had that time with a person they love whilst they’re dying. However, unfortunately it was necessary. As nurses we had to support the visitors with putting on and taking off the PPE which was bit strange for all parties. I found it especially odd as I’ve never worked in intensive care where you have to be strictly barriered and wear masks.
All of the Corona positive patient’s bedding and washing had to be kept within one area and taken out with pots, and everything had to be washed in a different area of their own. I would go into the room and do everything I needed to do; rather than going in and out as we would do with other patients. Each room at the hospice has blinds on the door so that we can check the patients are alright without disturbing them, but it must’ve been very isolating for the patient. It’s very sad that someone has to be like that when they’re dying: it makes it even more of a struggle. One of the virus’ symptoms is bringing up a lot of sputum, so it goes all over sheets, and the patient then has to be very contained as we move the sheets around. That experience will probably stay with me forever.
If you would like to help our nurse like Amie at our Hospice provide specialist care to families, please consider making a donation - https://www.standrewshospice.com/st-andrews/get-involved/donate/