Covid-19: “These are the most difficult conversations nurses have ever had”
14 May 2020
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To mark the theme of this year’s Dying Matters Awareness Week, ‘Dying to be heard’, we speak to the chief executive of St Luke’s Hospice Plymouth, Steve Stathan, about ensuring patients stay connected to their families despite the restrictions of COVID-19.
Hospices have introduced restrictions on patient visits to limit the spread of Coronavirus. Who is able to visit at the moment?
It will vary, as each hospice has their own arrangements around this. We decided to limit visitors to those patients that are really at the end of life, so patients in the last couple of days or few hours of life. When we get to that situation with them we'll let up to two people at a time visit.
We try to do it on a case by case basis, and be as compassionate as we can, so we won’t be strict on telling people they can only spend one or two hours with their loved one. We're trying to protect the safety of everybody, whether it’s our existing patients in the inpatient unit, the visitors coming in, or our own staff. It's a tough decision to limit the number of people who can visit, and it's really challenging for the nurses and medical staff who manage it.
What is it like having to explain to people they can’t visit their loved ones?
The nurses tell me these are the most challenging, difficult conversations they've ever had. They have to explain this to people who are actually pleading with them to see their loved ones. It causes anxiety among the nurses, and they feel it very personally because they put themselves in their position; they feel a lot of empathy. But even though it's not a comfortable discussion and it’s challenging, they know it's the right thing to do.
The other day we had a gentleman and a very young daughter who was showing symptoms of COVID-19. Of course we couldn't let her in, and he was so distraught about wanting to see her. In the end we managed it by letting them speak to each other through the big window in his room, but the nurses really felt for them because they couldn’t hug. If you speak to the nurses about it they’ll tell you situations like these can be pretty crushing.
Are there other ways of patients staying connected to people outside the hospice?
We have iPads in the inpatient unit, so patients can Skype or Zoom with their loved ones. We’ve found that even the patients who haven’t used this sort of technology before have been very receptive to it so they can keep in contact. That’s been great to see.
How are staff taking care of their wellbeing?
As an organisation we take the wellbeing of our own staff seriously. The nurses at the inpatient unit are pretty good at coming together as a group and sharing their experiences and feelings. The challenge is sometimes in the community, where the nurses may be a bit more isolated and are having different conversations with individuals about referring them to the inpatient unit and having limited time with their family. We're trying to ensure this group of nurses comes together using technology, and having meetings via Skype and Zoom has really helped stop the isolation.
We offer all our nurses external counselling. We've also been encouraging other wellbeing measures, like mindfulness, and there are resources they can tap into with the NHS as well.
Are people having more conversations about end of life plans because of the pandemic?
It’s at the forefront of people's minds much more than it was before. We're trying to ensure some of those discussions are happening before people come to the hospice, as part of our role is reinforcing the importance of having advance care plans and treatment plans before end of life care is needed.
I think there's a general awareness out there amongst the public and healthcare professionals, that the sooner we get advanced care plans in place the better it is for everybody. But there are situations where we'll have a patient come in who’s never had those conversations, and it’s left to the nurses or the medical staff to talk to patients and their loved ones about it. That still happens and will always happen when you deal with end of life because of the nature of the subject - people don't want to approach it.
We also try to educate general healthcare professionals, including our own staff, around having those challenging conversations about end of life. But they're not easy conversations, some nurses will feel more comfortable than others having them.
We still have a long way to go till we get everybody comfortably talking about death and dying, but it feels like there's a bit more of awareness around it now. People are questioning their own mortality more, as they’re seeing all the deaths being reported on a daily basis. It's only anecdotal but we’ve seen more people start to make a will which is great.
Is COVID-19 encouraging people to talk more openly about death and dying?
I think it is, when you’re living through a pandemic that is bound to happen. The question is, when it's all over will we have an environment where we can continue to have these conversations? I think that will be the challenge.
