Helping People to Live and Die with Dignity at the Royal Stoke

Taking care of people at the end of their lives can be an emotionally demanding job at the best of times, but what has it been like for the hospital’s palliative care team during the Covid-19 pandemic?

As we mark one year on from the start of the first lockdown Nicki Morgan, team lead for palliative care, has spoken about their experience of helping people to live – and die – with dignity during this unprecedented time.

During the second wave of the pandemic 75% of patients referred to the team had Covid-19.

Nicki said: “Caring for dying patients has always been an important part of our role, but despite our skills and training, at times the number of deaths from Covid-19 has felt overwhelming.

“The pandemic has brought a whole new level of challenge and sensitivity to what we do. Usually we support families face-to face at the bedside as we help to explore and meet their needs, but for safety reasons we have had to severely limit any physical contact. Undoubtedly restricted visiting adds a new dimension to people’s grief, so we have tried our best to bring people close through video calls and messages and recently we advocated for a husband and wife, who had both contracted Covid, to be together on the same ward and next to each other in their final hours.”

The team were determined to actively support colleagues and soon began visiting wards to identify Covid-positive patients, offering staff support on symptom management.

Nicki said:  “We found that patients with severe Covid-19 would often become very breathless and agitated. Sadly, the speed of their deterioration didn’t give families or staff much time to process events, but as a team we worked to provide guidance and advice on how best to ensure a patient’s comfort. We kept in close contact with ward staff face-to-face and by telephone, supporting them so they could start symptom control as quickly as possible. Provision of information and communication at this time is key and we found that patients, families and staff appreciated being put in the picture about things. Because of the work we’ve undertaken we are now better able to understand the impact of Covid-19.

“We really wanted to help colleagues and we saw that ward staff in particular were fatigued, tearful and overwhelmed at times. Although they are healthcare professionals, they are not used to caring for so many dying patients at one time, so we extended support to offer ‘one-to-ones’ or team defusing sessions.”

During the course of the pandemic the team maintained a clinical service, triaging and responding to referrals, which included discharge planning and helping patients get to their preferred place of care. They also worked closely with A&E to initiate ‘grab bags’ which provide anticipatory medications for patients to take home, meaning they can be discharged without the need for admission.

Virtual training and continued professional development for staff has also been a key focus for the team and they worked hard to provide training materials and infographics which would help clinicians when having complex conversations over the phone. They also encouraged the use of digital conference tools with relatives so that everyone could stay in touch as much as possible.

In normal times, the palliative care team work to improve quality of life for patients living with life-limiting illnesses, providing care throughout the duration of their illness.

Nicki said: “One of the most difficult things about the past year is that it’s sometimes felt like our only job is to be there at ‘the end’ for people. Whilst this is an important and worthy role, as a team we usually offer so much more than that, and it’s been frustrating to feel so limited in the scope of care we can offer. As we begin to think about recovery, we will continue to develop the levels of support we can provide and we will work hard to help people understand how we can be there for them to help enhance their life, not just their death.

“I’m incredibly proud of the whole team and how everyone has worked over and above normal expectations. We have pulled together to make sure we still give the best possible care, even during these most difficult times.”

Staff around the trust have expressed their appreciation for the support of the palliative care team.

Stacey Smith, Sister on Ward 126, said: “The team have been a massive support to us. They have helped patients, staff and families through some very difficult and sensitive times. Everyone is very approachable and always willing to help.”

Mark Brown, Medical Examiner, said: “As the number of deaths has increased due to the pandemic, I have observed more medical notes on patient records from members of the palliative care team and it’s clear from this that they are playing a really crucial role in patient and family care. Part of my role is to ensure families have all the information they need and that there are no unanswered questions around a loved one’s death. The palliative care team’s work reassures me that all the right processes have taken place leading up to a person’s death and is essential in assuring good clinical governance overall. Clearly, the work of the team has increased over this last year and we really appreciate their efforts.”

The team are now inviting staff to share their experiences of living through the pandemic in an effort to help them process things mentally and emotionally. They have also spoken about the effect the pandemic has had on their own lives.

Fiona Read, Specialist Palliative Care Nurse, said: “It’s been a massive challenge to balance everything. The pressure to protect our own families and to be there for our children and parents whilst also fulfilling our duty as nurses and supporting each other has been enormous. Our job is very emotionally and psychologically demanding and meeting up to have a chat and help each other diffuse usually makes a big difference. However, due to restrictions we can’t have our usual group chats where we would sit together at lunchtime and catch up. Because of this it sometimes feels like we are working in silo and we’re unable to debrief or support each other as often as we’d like to.

“It has been really frustrating not being able to meet face-to-face with relatives and have those very difficult but necessary conversations, it really isn’t easy over the phone or on Zoom. At times it has felt like our role is purely to support patients as they die with Covid-19, because we usually do so much more than that. It can be overwhelming and it’s been bleak to see the impact on patient’s families and staff around the hospital. I have really appreciated the wellbeing sessions at work. They have helped me to focus on looking after myself as well as others and have been supported by my manager. They have helped me to keep working and I feel really proud to have maintained my mental health during a global pandemic.”

As the pandemic continues into its second year, the team will keep providing support to patients, families and staff.

Tony Walley
News & Sport Editor

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