Hospice nurse describes how Covid-19 has changed her work

But since the start of the Covid-19 pandemic, with lockdowns, social distancing guidelines and other restrictions, much about her job has altered.

Home visits have required personal protective equipment (PPE) and other precautions while technology and home working have also played roles.

Katie, 41, said: “Ordinarily, we have face-to-face appointments with patients - either in their own homes or in clinics if they are well enough to attend.

“Since the pandemic began I’ve had to completely change the way I work. I still visit patients, however, wherever I can I provide video and telephone appointments and assessments.

“It can be challenging not having that face-to-face contact, especially when having difficult conversations. I’m used to putting a hand on someone’s arm or hand when they are upset, but I can’t do that anymore, and I have found this quite tough.

“Contact is important for building up trust – patients want to know that their nurse really does care and that it isn’t just a job to them.

“As a nurse I want to provide care and compassion and it has been difficult showing this without being physically close.”

Kitted out in her mask, Katie makes varying numbers of home visits a day and carries out all other consultations remotely.

Katie says the pandemic has made those visits even more important than ever.

“When patients have been given a life limiting diagnosis I often find they are anxious and fearful,” she said.

“They are particularly anxious at the moment due to the Covid-19 pandemic and the restrictions it has placed on their lifestyle and the contact with those they love.

“In this situation a smile from another human being goes a long way. Having a sense of humour is important too. We do still laugh in spite of everything but it’s much easier when you’re physically with a patient.

“A recent example happened a few weeks ago: I had forgotten to wipe my lipstick off before I put my mask on, and on removing my mask it smeared all over my face, although I felt self-conscious, it made the patient and his family laugh!”

Another challenge which has presented itself is assessing patients without seeing them.

“It can be hard to get as much information as you would with a face to face visit,” said Katie. “I am continuing to visit patients with complex symptoms that are difficult to assess over the phone or video and those patients who are suffering severe anxiety. Some of those patients who are very anxious may call 999 and be taken to hospital unnecessarily.

“Therefore if my visiting them every few weeks can prevent this, it’s absolutely an essential visit. If patients are going into hospital who shouldn’t, it puts more strain on the NHS and it’s distressing for the patient and their family.

“At the moment anxiety among many patients is running high. A lot of them are afraid of the virus and I can hear the upset in their voices. Many of them don’t live with families and are in isolation, so families are restricting any face-to-face contact to keep their loved ones safe.

“Our patients have been given a limited life span already and, now they are discouraged from seeing those they love to keep them safe, many patients have stated they feel robbed of making memories with them in the last few weeks or months of their lives.

“This virus is eating away the time with their families. Patients are saying they don’t know how much time they have left and only want to be with family but can’t.”

Katie started working in the Hospice Nurse Specialist team at the Hindley-based charity in October 2017. She qualified as a nurse in 2009 and before then worked as a bank auxiliary nurse.

It was when she was an auxiliary nurse that she discovered her love of palliative care.

She said: “I did a lot of night shifts when I was an auxiliary nurse and student nurse and there was one particular patient on the gastro-intestinal ward who was at the end of life. Over three nights I supported him while he was dying, his wife and friends were present throughout.

“I wasn’t able to change the overall outcome, but I was able to care and talk to him and his family. Making them comfortable, during his last days of life and supporting the family after his passing. I saw the difference care and compassion could make and I realised at this point that a good death makes a difference.

“I honestly believe death is as important as birth. A ‘poor’ death not only affects the dying person but impacts on those who are left behind. A ‘good’ death can allow families to grieve much easier and take forward positive memories of their loved ones.”

For now Katie is based mostly at her Wigan home and admits she is missing her colleagues.

She said: “By working together as a team we have been able to adapt how we provide care and support each other and our patients in this difficult time. Our team is really close so it’s tough not seeing them every day.

“However, we are in contact over video and although it’s not the same as giving each other a hug after a hard day, we find our daily phone or video calls have ensured we remain the amazing team that I am proud to be a part of.

“I love my job. I feel extremely passionate about the care I deliver and the importance of it. Though it is challenging, it is extremely rewarding.”