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Sophie Peach knew that working in palliative care was for her when she completed her nursing degree several years ago. Here she outlines a typical day caring for patients in their homes.
We squeeze as much as we can into our day working at Ashgate, just to make life a little easier for those that we care for. It is hard and there will be tears, devastation and heartache, but there is also love, laughter and life.
I was 18 years old when I started my nursing degree, and my very first placement was working on a palliative unit. I was extremely anxious and so were my family – there was the expectation and assumption that I was going into nursing to help save lives! I didn’t know what to expect. I had no idea the impact that palliative care would have on me and how that one placement would change my life and attitude forever.
I have learned a lot about myself as a person and a nurse, but mostly that palliative care is focused on quality of life, not just death. It was the most meaningful thing I had ever done, and I knew that this was the area I wanted to work in. A lot of challenges followed and here I am at 27 years old, a Palliative Care Nurse within the Community Specialist Nurse Team at Ashgate Hospice.
Morning – checking in with our most poorly patients
My day starts officially at 9am with morning calls to our most poorly patients, checking on how they are doing and how they have been during the night. Then there are several morning meetings where I catch up with my fellow nurses, our consultants and other healthcare professionals, who provide us with advice on how we can care for our patients with the most complex illnesses and symptoms.
Amanda Hall and I cover the ‘Hardwick’ area – from Tupton and Grassmoor in Chesterfield, right down to the outskirts of Derby and Alfreton. On average we have around 20 patients on our caseload to monitor and support, this can be as high as 40 sometimes – it is all dependent on referrals and discharges. Some of these people will need daily support or even multiple calls a day if there are lots of symptoms and issues, others may just need a weekly review. Sometimes phone calls are enough but other times visits are needed. There is no set plan for all patients – we personalise our care and respond as we need to.
On an average day we do two visits, which usually take about one to two hours each, and multiple telephone assessments. My travel time is only around half an hour in my area, but for the nurses covering some of the more distant places it can be as much as two! Sometimes one day can be fully taken up by trying to help and support one single patient and their family. But I like to think if it were me in that situation, it would be the biggest relief to know that there are people that can help like that.
Lunchtime – reassuring a patient and their family in crisis
At midday I visit a lady at home who is seriously unwell and things for her were changing quite rapidly. She had been struggling with a lot of symptoms. It was my first visit to meet them, and her family wanted me to admit her to Ashgate’s Inpatient Unit as they were understandably terrified, but the patient’s wish was to be at home. I spent a long time reassuring the family and going through the options that we can help implement, helping to mediate between them. I did a full assessment and gave some injectable anti-sickness and pain relief to relieve her symptoms. We discussed and formed a plan to better manage her symptoms with different medications and talked them through how to use them.
I spent some time with the family separately to show them practical things about how to safely transfer her and move her in bed and gave them some incontinence pads and showed them how they work. We agreed on a plan for a bigger care package and referrals to all charities available for additional night support, which I completed in my car outside to avoid any delays – even managing to secure them some support for the following night! We spoke about common things to expect and talked through some of their fears. I linked with our Occupational Therapists and Support Workers, as well as the GP and District Nursing team to ensure they would get involved and support too.
It was a long, emotional visit and we had to have a lot of hard conversations. But there is nothing like walking into a house that is tense and full of fear but leaving with patients and their loved ones smiling, seeing them have a flicker of hope again. It is the best feeling in the world. The patient’s daughter commented that she ‘never knew the hospice could provide such care and reassurance even at home’ and that is exactly why we do what we do. Hospice care isn’t just about the care we can provide in an inpatient setting or at the end of life, it is so much more than that. So, I smiled, reassured I would check in on them later, took a deep breath and headed off to Tibshelf for my next visit. Ready to do it all again.
Afternoon – respecting a patient’s end of life wishes
It was approximately 3pm by the time I got to my second visit. I was supporting a gentleman that I had met a few times, so we already had a good rapport. He had recently been told his disease had sadly spread further and he wanted to talk about his future wishes with me. So, we spent an hour chatting through and documenting what he wanted to happen, as well as what he didn’t. I gently asked about his preferences for his care, and we did talk about resuscitation. He spoke about not wanting to go to hospital if he could avoid it and that is important for us as professionals to know. But I also asked about his favourite hobbies as well as who and what is important to him. I learnt so much about them as a family and felt extremely privileged. Both he and his wife cried and laughed during that hour. They reminisced and spoke of their memories and some of the things they would still like to do. They said that as sad as it is to have to think about some of the things we talked about, it was also a relief that and they thanked me for making it a positive thing to do. It helped him see a future.
After visits and telephone assessments I quickly get home, grab a drink, and document my previous visit, ensuring that patient’s records are updated fully and clearly. Our day ends at 5pm, although there’s never enough hours in the day, but I wouldn’t want to do anything else!
I have been at Ashgate for four years now. I spent two years on the Inpatient Unit before joining the Community Nurse Specialist team in 2019. It is the most challenging, but rewarding and worthwhile place to be part of.
My friends and family often ask me why I do this job; I can see why people mistake it for being all doom and gloom. But those of us who do this know that it is a special and privileged role to have.