A day in the life of a hospice: 24 hours of care during a pandemic

Nottinghamshire Hospice share what 24 hours of the care they provide looks like while the Covid-19 pandemic is ongoing.

Nursing Team 1 start the day at around 8am, making visits to patients in their homes. At the same time the hospice’s Griefline opens, providing 12 hours of signposting and support for bereaved people across Nottinghamshire.  

At 9am Nursing Team 2 start their shift, also getting out to patients in the community. Working during the pandemic has been tough for key workers, but the lovely posters, banners and signs people from the local community have been making for them have kept staff morale up.

During the mornings the teams go from home to home, supporting patients, giving practical care including washing, pressure care, ensuring medication is taken and making sure everyone is as comfortable as they can be. They answer questions and make sure that families know what they can expect and what future support might be available.

Nurses check patient notes throughout the day. They work with GPs and district nurses and liaise with other support services regularly. This is to ensure that optimum care is reached via collaboration across these networks. Round-the-clock care takes a lot of planning, so they’ll be organising care plans for tomorrow too.

At midday it’s time for a socially distant cuppa and a catch up. Everyone reconvenes at 12-ish and discusses the morning briefly. Once a week there is an in-depth case conference including physiotherapist Mel, Hospice In Your Home manager Wendy and Hospice at Home lead Felicity. Patient care is also discussed at this meeting. 

Nursing Team 1 and 2 are back out in the afternoon to continue assisting families and patients. Throughout the Covid-19 pandemic, the hospice’s services have continued daily across Nottinghamshire, however the way they work has changed in many ways.  New services have also been launched to meet demand and amongst the nursing, emotional support, bereavement counselling, hospital discharges and therapies that happen across the county daily, there’s always lots to do.  

Nurses and healthcare assistants are working really hard on outreach right now to care for families and patients. They are making physical adjustments and giving advice and care to reduce mental and physical distress. This is happening round-the-clock every single day.

At 4pm Team 1 are finishing their day. Before they go they complete their handover notes, ensuring the right information is passed to the next team, checking the capacity of the service and ensuring they’re up-to-date with any new referrals. Team 2 finish at 5pm.

In the evening the twilight healthcare team assembles at the hospice. They get ready for a long and often unpredictable night but they are trained, prepped with PPE and ready.

Sarah is the Lead Nurse directing the Night Support Team. She was a registered nurse for 38 years and had retired from service, but re-registered as Lead Nurse after the NHS called for retired nurses to return to work.

The Hospice Night Support Team start their shift at 10pm, and will be responsive until 07:00. Staff on the Night Support teams spend between 30 minutes to 1.5 hr with each patient. Asked how they feel about their shift tonight, one team member says:  “It’s hard to say what’s helped us through the pandemic to this point. It has been an enormous effort, we’ve transformed services and launched our new twilight service. It’s great to be part of new developments. Our team have done and are doing everything possible to work diligently through this extremely testing time. That’s all we can do for now.”

Throughout the night the team are in and out visiting patients at the end of life who need them, but also providing emotional support and practical advice over the phone to family members who are anxious. The shifts can be draining both physically, mentally and emotionally. Patients’ needs change rapidly and the anxiety felt by the nation at present is shared by staff, patients and families alike.

By midnight the hospice may look quiet, but staff are working every moment. All the patients are vulnerable with existing conditions which means they are especially vulnerable to Covid-19. The teams must be prepared to be very responsive to rapidly-changing patient needs and to quickly adapt to changes in government guidelines. At the moment demand for services is extremely high, staff are all doing extra shifts and this way of working requires a lot of goodwill and hard work.

During night times the teams see 90-100 people a week. Tonight, like most nights, they will make repeat visits to patients where necessary, and the care they are receiving suits their often rapidly changing needs. This is really important to ensure people can have as planned and comfortable deaths as possible. The early hours can be a very difficult time. The teams allow families and carers to rest while they know their loved one is in safe hands.

At 6am the sun is now up, and it’s almost time for the night team to hand over to the day team. It has been a long night of ensuring patients have the right support in place, that practical care and personal hygiene are taken care of and that everyone is as comfortable as possible.