We are a charity supporting patients and their families facing life limiting illness –both at home, in care homes and from our Gravesend-based hospice.
In fact – and, perhaps, in contrast with common assumptions about hospice care –the vast majority of individuals under our care are looked after from the comfort of their own homes. A small few, however, are treated in our inpatient ward (IPW), where they receive round-the-clock palliative care from a core team of dedicated nurses.
The IPW’s seven beds, as our Operational Lead Chris Dyson explains, support people predominantly over the age of 18 (although may take individuals as young as 14, if the need arises) living with a “broad spectrum” of complex, life-limiting conditions. That could mean cancer, chronic respiratory illness, motor neurone disease, or anything requiring palliative treatment.
“Because we’re classed as a specialist palliative care unit, we can focus specifically on a holistic approach. We cover all the patient’s needs, whether that’s personal care, wellbeing, physical or mental, spiritual, or pastoral –it’s all in our remit”.
This is also, Chris explains, one of the key advantages a hospice setting provides over that of an acute hospital. Moreover, it’s what allows the nurses of the IPW to “treat the person and the family, as opposed to the disease”.
Chris’ role involves running the ward on a day-to-day basis. It’s a split which she describes as 40% clinical and 60% managerial; taking care of patients, while also coordinating the extensive network of services that cater to all aspects of the patients’ welfare.
This web of contacts –which includes GPs, social services, physiotherapists, a wellbeing team, and occupational therapy, among others –is vital in ensuring that patients continue to be supported, even after they’ve left the IPW for home. It’s all part of what Chris calls the “holistic approach to a discharge”.
“We always let GPs know when someone’s been discharged. We might also need to refer to social services for a package of care. We work closely with our Hospice at Home team, too, to make sure that the patient is followed up when they leave here. It isn’t just ‘you’re discharged, that’s it!’”
Chris had been in her role for just six weeks when the coronavirus pandemic began –bringing with it seismic changes to how the IPW would operate.
The number of beds more than doubled to 15, as the IPW opened its doors to 'step down' patients, to support the local acute hospital and other health and social care providers. Our IPW provided a kind of ‘bridging gap’–a safe place for these patients to recover, before being reunited with loved ones.
Alongside the myriad logistical concerns that come with higher patient numbers, it was adjusting to a new kind of patient, Chris says, that was most challenging for her nurses.
“It was a huge difference for the staff, because they were looking after patients that weren’t palliative, and people with illnesses that weren’t commonplace to what the nurses were used to. They had to adapt to the fact that these people had a different set of health needs”.
Balancing the wishes and involvement of the family alongside health and governmental guidelines has also been a key –if demanding – focus. For instance, while the wearing of PPE has been largely welcomed by families, it’s still been difficult to get used to for all involved.
“The hardest thing we’ve witnessed is a relative with PPE –which includes the wearing of gloves –that wants to hold their loved one’s hand. We try and convey the risks, but why would you stop someone taking off a glove to hold their husband’s hand?”
Normally open almost 24 hours a day to visitors, our IPW has also been forced to all but stop the frequency of visits by family members –something which Chris feels “goes against the hospice ethos”.
“It’s hard for the patients, and for us as well –because we’re the ones saying no. If we put ourselves in the patient’s shoes, how would we feel? That has been one of the toughest aspects of COVID-19”. Sadly, it’s also led some patients to turn down admission to the IPW, knowing that the current guidelines will limit their family contact there.
To an extent, at least, the impact of lockdown restrictions has been lessened by the IPW’s embracing of video conferencing tools such as Zoom, which help keep family members in the loop. And there are certainly still some silver linings. Chris and her team recently had the pleasure of sending home two centenarian patients –one aged 100, and the other 102 –both of whom had made full recoveries on our Inpatient ward.
It’s this positive outlook, Chris suggests – and not the “doom and gloom” often associated with the palliative space –that’s more representative of our IPW.
“Despite what our work is, we still find the time to laugh with our patients. There are still lots of smiles. But above all, we’re still here. We’re still helping. We still care”.
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