Enabling quality of life in very difficult circumstances, by Kate Plant

19964730_1773600412654889_568888045_nA thought provoking guest blog, second year CYP student nurse Kate Plant shares her experiences and insights into palliative care from her DILP summer placement…


Before starting my nursing degree, I volunteered as a Sibling Support Worker at my local Children’s Hospice. So, I already had some idea about how special these places are. But it was not until I undertook my Elective Placement there that I realised how rewarding a nursing role, in the provision of Palliative Care, can be.

The first thing I noticed was the difference in pace, compared to my previous placements. I was used to dashing around on hospital wards and barely having a moment to drink. So, when I was offered a cup of tea on my first day (half an hour into my shift) I was completely taken aback. But, obviously, there were more significant differences than having the time to quench my thirst. A patient would be allocated both a nurse and a care support worker, on a 2:1 basis, due to the complexity of the patient’s needs. This 2:1 care gave nurses time to listen and understand what really matters to the patient and their family. There was no rushing around. The environment was relaxed. Families would allow a nurse and other staff members to enter their lives in very difficult circumstances and build strong relationships with them. This is where the satisfaction came in.

CYPIn addition, I have by no means observed doctors, nurses and care support workers work together as well as within palliative care. There was no division but instead, a sense of unity. This enabled a pleasant atmosphere to bloom within a setting which, stereotypically, has connotations of being constantly surrounded by upsetting situations. All staff members were part of a team, encouraging a family atmosphere so families were as comfortable and happy as possible. Staff were able to take away a families’ everyday stresses so children and their families could treasure the remaining time they have together as a family, however long this may be.

The thing that struck me the most was the parent’s enormous strength to keep a pleasant face for their terminally-ill child and their other children, in one of the hardest times they can ever face. A parent’s strength is aided through their ability to effectively plan, with help from compassionate and empathetic staff members, any wishes they have in the care their child receives before death. This includes preferred place of care, spiritual and cultural wishes and anticipatory symptom management planning.  With such a wide array of resources available at the hospice (including sensory rooms, adapted garden swings, music rooms, parent bedrooms, bereavement rooms – the list could go on and on) these wishes were almost always met.

TOGETHER_LIVES_RESIZE_800_450_90_s_c1_c_cLast year, the ‘Together for Short Lives’ charity reported a national shortage of children’s palliative care nurses which is negatively impacting on the care provided to children and families. I truly believe if other students and qualified nurses were to gain a deeper understanding and/or even experience how rewarding roles in Palliative Care can be, this could help bridge the care gap. After all, you’ll never regret making a difference in the quality of care a child or young person received, during their last moments of life.

My day with the Health Visitors

As an adult student nurse, I don’t encounter many babies/children, so I was keen to try something a bit different. So when I found out that the Health Visitors were just down the corridor of my placement’s main office base, I soon popped my head in to organise a spoke! I had an absolutely wonderful day with the team! Not only did it help me understand the workings of the Community Multi-Disciplinary Team, but its exposure to another field of nursing! Plus, my current district nursing placement is largely based around treating patients, so observing some preventative public health care was great. Oh, and I got to play with some adorable children- I love being a student nurse!

Each Health Visitor is a qualified nurse (adult, child, mental health or learning disability!) or midwife, and their role is based around family care. By leading the delivery of the Healthy Child Programme, they ensure that expectant mothers and new babies up to the age of 5 get the best start in life! They visit families in their homes, GP clinics, Nurseries and Sure Start Centres. It’s an incredibly varied job.

pincer grasp

A tiny grasp for baby, a huge step for development!

My day with the Health Visitors started with a visit to a local SureStart centre, where the local ‘Baby Clinic’ is held. This is where one year old’s attend and the health visitors evaluate their progress. Its not as scary as it sounds, I promise!! They look for certain markers in a baby’s development and then, if needed, can give the parents pointers on how to help their child. For example, by the age of one they should be ‘babbling’ (repeating words they’ve learnt, usually nonsense), pulling themselves to stand and using furniture to wobble around on two feet, and using a pincer hand gesture. We had two lovely little babies visit us, both of which showed these developmental markers but at different stages. Each child, of course, is different and they have started to develop their personalities at this point. Our first baby was very outgoing and had his older sister to make him confident enough to play around and show us how well he was doing. The second child was a bit more shy, and preferred the company of her mum. However, after I showed her the wonder of some bells on a stick, she did everything we asked of her.

Alongside looking for the developmental markers, Health Visitors are also looking at the bigger picture. Their aim is to ensure that the family is happy, healthy and safe. How do you do this? Use a good old pyramid of course!

health visitor bible

Who doesn’t like a pyramid?

The Safeguarding and promoting welfare pyramid is designed to help pinpoint the areas which children should have. So, for example, if the Health Visitor detects that the child doesn’t seem like they have enough stimulation for the child to grow and enjoy themselves, that would question the parenting capacity. It’s useful for identifying a variety of factors that may be affecting a child’s development, as it’s never usually just one thing. Anything that is identified as missing can be worked on, via the Health Visitors, Social Workers or Family Support Workers.

If you want to learn more about Health Visitors, NHS England has a load of information about their role and how to become one! Or, if the chance arises, go and spend time with some!

Trauma Talk

Witnessing a distressing or traumatic event is something you expect when you start a nursing degree. I remember when we did our Basic Life Support for clinical skills many moons ago, and the teacher made a point of saying “when you need to use this”. I’ve been taught CPR before, and the instructors have always said if. Suddenly realising that you may be the only person to help in a traumatic situation is kind of terrifying.

trauma call

I had my first experience a few weeks ago. I was on an optional training course at my placement, learning alongside students and Health Care Assistants. On our way to the next talk, one of the group members collapsed, had a fit and sustained a pretty nasty head injury. Fortunately, there was a qualified nurse on hand and soon enough there was loads of help arriving too (watching 3 doctors run towards you, stethoscopes at the ready, is like being on a TV show). I just stood and watched, and felt completely out of my depth. In theory, I knew exactly what to do. Call for help, avoid getting too close until he’d finished fitting, compress the head wound and maintain his airway- but I was terrified. I like to think that if I was the only person there who could help, I would have done those things on auto-pilot. But being an observer is different, especially since I’ve never seen anything like it.

Once the casualty was taken to A&E, the nurse who was teaching us took myself and another student nurse aside, and asked us if we were okay. She told us that she’d check on him later and update us tomorrow. I felt better after that, plus I still had adrenaline in my system and it was fantastic to see how everyone worked together. But as soon as I finished my shift and I called my dad, it started to feel more real. I suddenly felt really spaced out and didn’t want to go into detail with my friends once I got home. I couldn’t believe that it had actually happened. Luckily everyone was super understanding and gave me my space. My housemate even made me dinner!

jades dinner

I’m very lucky to live with someone who can make amazing food. 

Everyone listened wonderfully and were really supportive. The next day I was informed that he was doing better, and that was the best news.

The way that people dealt with that situation, and how immediately supportive people were gives me a lot of hope for the future. Nursing is a demanding career, and you will have bad days. But having colleagues, fellow students, lectures/advisers at uni,  family, friends, partners, maybe even a dog to listen to you is amazing. Just keep it strictly confidential! Its these people who you make you strong enough to carry on and get to experience the good days too!

Relatively speaking…

Although – thank goodness – not everyone will have had the opportunity to experience being the relative of someone in hospital, it definitely helped me learn a great deal about speaking with the relatives of my patients.

I am also very grateful to my mentor at the time for helping me to extract the learning out of my experiences on the other side of the nurse-relative relationship. Without her prompts to reflect on how my time as a relative had changed my perspective on nursing, I may have let valuable opportunities for understanding and growth go by the wayside.

talking

Immediate family, carers, distant relatives, friends – some people may find communicating with them extremely daunting at first.

I was very nervous on my first placement. What if I say something I shouldn’t or give incorrect information? What if they are unhappy about a student helping to care for their loved one? What if they ask me tonnes of questions I don’t know the answers to? What if, what if, what if…

I know it sounds corny, but I always remember this line from the crime drama Cracker.

“People say nothing…cos they’re frightened of saying the wrong thing. But it’s better to say the wrong thing than nothing at all.”

Now of course this doesn’t apply for absolutely everything, but on the whole, I feel you’re more likely to do damage by staying quiet than you are by trying to engage with relatives.

It gets better. The more comfortable you are in your environment the better you will feel about speaking with confidence. Focussing on listening, rather than talking, makes conversations flow so much more easily. And although that might seem obvious, when you’re nervous and uncomfortable it is simple to accidentally keep talking when you should be listening.


I have a few take home messages from my experiences as a relative caring for a family member who was in intensive care after a major emergency operation:

  • Introduce yourself clearly, make certain your name badge is visible. Try to say your name at least twice.

I tend to say, ‘Hello, my name is Heather. I’m a student nurse and I’m helping to look after ___ today.’ At the end of the conversation I make sure I say my name again and touch my name badge to draw attention to it, ‘So, yes, I’m Heather and if you have any (more) questions I’ll be around.’ It can be a bit awkward saying your own name over and over, but as a relative you can feel quite rude not knowing nurses’ names but many don’t make it easy for relatives. Wearing your name badge/card on a lower pocket, turned backwards because you don’t like the picture of yourself or not wearing it at all can be hugely irritating to relatives who want to start a conversation. Remember, they will have other things on their minds and remembering a raft of new names will be the last thing on their to-do list so don’t make it any more difficult for them.

  • Ask, ask and ask again if the relatives have any questions.

It can be very upsetting not understanding what is going on. What is this tube or that tube for? How are they eating? When will they walk again? What will their life be like in 1 week, 2 weeks, 3 months? Although some of these questions can be answered and others cannot, letting people ask them and doing the best you can to answer gently and honestly will help. And don’t just ask once and assume they’ll never have any questions again. Ask when they come in, ask when they’re leaving and ask every time they visit. Don’t just assume they’ll get your attention if they want to ask something. I spent a great deal of time battling silently with myself thinking, ‘I want to ask (y) but it seems rather trivial and I already asked about (x) but I hadn’t thought of asking about (y) until just now and I don’t want to be a bother as I know they’re busy but…’.

  • Make yourself available.

Stay close, make eye contact every once in a while and don’t be afraid to interrupt and just check if they have any questions or need anything. You don’t need to hover right over them, but some nurses have a tendency to completely disappear during visiting times which can be very disconcerting for relatives. I’ve also watched nurses expertly avoid eye contact with relatives when they were walking past to avoid engaging.

  • Everything revolves around making certain that relatives feel they can trust you to do the best for their family member.

It’s very easy to start to worry that things about your relative aren’t being noticed and that their care is being communicated poorly throughout the team. From the point of view of a relative I can tell you that care can appear very fragmented. A different nurse on every shift, different doctors stopping to chat with patients, different physio teams coming every day. When you’re trying to talk to your relative about the care they are receiving and they have no idea who anyone is because no one has introduced themselves properly or informed you or your relative about any plans for their care, you start to lose trust in the healthcare team. When this happens, your first port of call is usually a nurse on shift. If that nurse is no where to be seen or avoiding eye contact with their name badge turned backwards, it makes everything feel even more poorly managed and inaccessible.

Family Matters

A lot of people always wonder how you balance everything at uni when you have kids. Well I can confirm it is very definitely doable. There are loads of mums and dads (step parents too) doing the course and finishing with fantastic results.

family

There is always extra pressure regards your time and how you do actually fit everything in, but it is a very personal thing and everyone and their situation will be different. Most placements are very understanding as a lot of the nurses out there have been where you are and understand your concerns. The healthcare workforce like any employers have a lot of working parents and are used to requests regards balancing shifts around childcare.

When you make that first call to your placement let them know then that you have kids so they are aware that adjustments may be required. Discuss with your mentor the shifts that you can work. Some parents do a couple of long days and then have a few days off with the kids. Others stick to the 7.5 hours per day as this fits with their childcare arrangements. You can also work weekends to help meet your required hours. There will always be a way round things as long as you are open to being flexible too in regards to getting the full learning experience and making the most of things whilst on placement.

baby

It is a scary thought but by being organised and utilising your time at uni and placement efficiently you can still have quality family time. Do what you can during core office hours and don’t put work off, do things when you get the chance.

Having support at home really does make the difference but never be afraid of speaking up if things are getting on top of you. Talk to your mentor and/or your AA as things can always be altered to help you out. Ask other students how they have managed things as peer support can be full of great ideas.

Your wellbeing is important so make sure you look after yourself too.