We’re all really proud of what we do and how we are doing it
Emma Dixon, a clinical nurse at St Ann’s Hospice, which has sites in Heald Green, Little Hulton and the Neil Cliffe Centre in Wythenshawe Hospital, tells of the challenges and pressures of working through the pandemic
WE are busy at the moment. We are continuing to admit patients with the main focus on delivering specialist palliative care and end of life care – and we are supporting patients in the community.
We do have Covid-19 cases and that is presenting new challenges.
We have stringent control measures in place, we are following the guidance to a tee. We have restricted visitors, reduced footfall, staff members who can work from home are, we have an in-house housekeeping team and the wards are as clean as they can be.
We are having regular virtual conversations and conferences to discuss how to manage working with families to make sure they are supported and, where possible, can continue to visit patients.
Some of our patients are here for end of life care, some for complex symptom management. They are patients who are managing at home okay but are suffering now with more pain or nausea or vomiting, or anxiety and their symptoms can’t be managed at home.
Family visits
At the moment, there are restrictions on visits, with only two visitors per patient. Patients are asked to identify those two visitors and children under 16 can’t visit unless it’s specifically agreed. Sadly, for patients with confirmed coronavirus, no visitors are permitted.
Some of the conversations around end of life care are difficult because those plans are very different from what the patients were hoping they would be.
Someone might have been hoping to be surrounded by family and that’s not possible with restrictions in place. All our staff are compassionate and want what’s best for patients but we know the challenges this is bringing.
We are having to be more than a nurse to patients – we are having to be with them at the really challenging times because family can’t get in.
We have virtual visiting although we recognise that’s not the same as having family to sit with you throughout the day.
We have had a kind donation of ipads and we’ve a new role in the hospice to specifically support visitor contact with patients.
We also phone relatives if they want us to touch base and let them know how their loved ones are doing.
But we are used to more family members being on site. If patients are having a low moment it’s quite often the family members who are with them.
Now there are long periods of time when patients don’t have family members with them and we are trying to be with those patients as well as doing our normal role.
We are finding psychological needs are greater at this moment in time, not just from patients but also families.
PPE
PPE is okay at the moment, we’ve been lucky up until now.
We did have deliveries every couple of days but now it’s every two weeks, that’s a significant change. We are in daily contact with those supplying us with PPE.
My biggest fear at the moment, as head of clinical services, is around PPE. I have to make sure there’s enough in stock. It’s a constant worry that we’ll run out and it has been since it all started.
It’s making sure staff can do their job the best they can, knowing they are protected.
But we are overwhelmed by the generosity of the community. People have donated full visors, gloves, masks, from veterinary practices. If there comes a point where we can’t get PPE we will have to review how we operate and we don’t want to do that.
Testing
We are very fortunate in that we can swab our patients if they are symptomatic of Covid-19.
We have introduced staff testing as well – and we have had positive outcomes. We have stringent control measures in place and we are following guidance to a tee.
The mask dilemma
Working in the masks, gloves, visor and aprons can be challenging. It gets very hot.
We pride ourselves on providing palliative care, with a focus on holistic care. We don’t just review the medical condition, it’s about the patients’ spiritual, psychological needs.
And I didn’t realise how difficult it would be in terms of non-verbal communication.
This morning, for example, I’ve got my mask on, my goggles, my gloves and apron. I’m going to say good morning to patients.
I introduce myself – and then realise they can’t see me smiling. All they can see is my eyes through my goggles.
All they’re seeing is a pair of eyes coming at them. They can’t pick up on my face, my movements, my nonverbal communication.
I asked one of my patients how it feels – not being able to identify me from the next nurse or the next nurse.
They said it was fine because ‘I can tell you’re smiling behind your mask because your eyes sparkle.’
I can still hold a patient’s hand if they need comforting but it’s not the same because I have gloves on. It’s not hand-to-hand. That’s one of the things I find most difficult.
Pandemic pressures
Like healthcare professions in all areas, we are feeling the challenge too. It’s hard at the moment.
We want to give the best care we can but due to restrictions we have to work differently.
We have more than 700 volunteers but because of the current situation we are all having to step in and do things they would normally do – like cover reception and help on the wards serving meals and refreshments. Staff are really mucking in.
As frontline workers all the hospice staff have their own families at home and many have their own worries.
We are following all the guidance and making sure staff are as protected as they can be but we all have that worry in the back of our minds. Staff wellbeing is a priority.
It can be hard on the ward and sometimes you just need some time out to take a cup of tea, sit, gather thoughts and then bring yourself back into the ward. The values we have here at St Ann’s means everyone is living and breathing those values at the moment.
We are all really proud of what we are doing and how we are doing it. Everybody is coming together and being so compassionate, professional and treating everyone with respect.
Everyone is experiencing different anxieties but are stepping up to provide the very best care for people.
Staying safe at home
I have a husband and two children. We follow the infection prevention and control guidance.
Staff only wear uniforms on the ward, we change into normal clothes and put our uniforms into scrub bags before we go home.
The minute I get home I wash my uniform and go straight in the shower. There is no contact between me and my family before I do that.
The hospice community
Unless somebody is being nursed in isolation due to infection our patients on the ward can move about within the hospice while recognising social distancing.
Relatives of our patients are so understanding. I get that it’s hard for them.
If they are Covid positive they can’t see a loved one or they can’t come as frequently as they’d like to, they can’t come en masse.
But people understand what we are doing, they are grateful we are taking the measures we are.
They are following the guidance and protecting patients and staff.
We are still celebrating birthdays, we have cake and if the family can’t get in the clinical team will go in and help to celebrate, take photographs so as much as possible life within the hospice is going on as normal.
We are making sure every single patient has their needs met the best we can but there’s an air of uncertainty for everybody I guess.
For me, though, the one big thing is the dedication of our team here at the hospice. They are really very special – every single member of staff, the clinical team.
They are all going above and beyond to provide care.
We are still receiving the most amazing feedback.
Fundraising
We’ve had the most amazing support from local communities.
People have brought in scrub bags they’ve made so we can take our uniforms home.
People bring us food, sweet treats, people donate to the Covid emergency funding appeal.
That’s important because we’ve had to cancel a number of fundraising events. We have to raise £20,000 a day through fundraising. But we’ve been overwhelmed by the support. Thank you.