ICSPCT News

by RN Jackie Watkins

My day starts when I log on to SystmOne to check the diary for my visits. The visits are never the same or predictable. It is important that I take the time to read the notes, to be aware of diagnosis and changes to a patients condition.

The visits then can range from:

• Urgent symptom management control. This is when a patient is having break through symptoms like pain, agitation, secretions or nausea and vomiting. These are the most common symptoms for a dying patient.

• Rapid discharges from hospital or hospice. This is when a patient is nearing last days of life and has requested to die at home. We assist them with that discharge.

• Assessment visits, these are the visits that we collect all the patient’s relevant information and plan their care going forward.

• Syringe driver set up, this usually happened when patients can’t swallow their oral medication or they have been having break through symptoms requiring regular injections. Once a patient has a syringe driver in place we then do daily visits to replenish.

• Bereavement visits, it’s always important to visit the grieving family. Sometimes they struggle after having so much support when their loved one was being nursed to it abruptly being stopped. I always like to let the families know we are still here for them if they need us.

We cover a vast area of Leicestershire and Rutland, travel is a big part of our role so you have to enjoy the driving. Due to the intensity of emotions after visits the driving can give us time to self-reflect and re-centre ourselves for the next visit.  

Our visits can vary in time depending on the patient and family’s needs. We do not only assist the patient during their journey but also with the relatives. We see all kinds of emotions and as you can imagine, we, as nurses, also go through some of these emotions, which is why you need a good support network at work with colleagues, which we are lucky to have as a team. It can, at times, be challenging and overwhelming, but very rewarding at the same time.

We only get one chance to get it right, our aim is to make every death a good death. Having the time to spend with the patients and family is paramount to our role and so excellent listening is an essential skill. The hardest part of this job for me, is knowing I can’t always fix every problem for all concerned, but I feel it an honour and a privilege to be trusted by families to care for their loved ones and for that I am grateful.

by Becky Procter (LOROS educator)

The past few years has seen a large number of new palliative care clinical nurse specialists (CNS) join the hospital and community palliative care teams across Leicester, Leicestershire and Rutland (LLR). This has led to a junior specialist palliative care nursing workforce.

After discussion with the nurse leads in these areas, LOROS’ education team developed a 2-day interactive programme to support the development of these individuals.

Delivered by palliative & end of life care educators, who’ve previously worked as CNS leads in palliative care and a palliative medicine consultant. The course consists of a variety of teaching methods including interactive and simulation-based, with the aim of enhancing specialist palliative care skills and knowledge including developing a deeper understanding of the CNS role, referral criteria and prioritising referrals to the specialist palliative care teams as well as recognising signs of deterioration and dying. The programme also focuses on the assessment and management of a patient’s symptoms, both physical and psychological. Other sessions included; understanding behaviours of colleagues and the importance of looking after ourselves.

Feedback has shown that the course consolidated existing knowledge, and created opportunities for new learning, improving confidence for those in the role. Specific areas identified by the CNS’s as being particularly beneficial were the symptom assessment and management sessions and the use of simulation training. The benefits of networking, understanding each other’s role and sharing experiences with other palliative care CNS’s across organisations in LLR was highlighted as being extremely valuable.

Following the feedback and success of the initial programme, this has been extended to a 3-day course and is due to be delivered again in March 2023. We aim to make this a rolling programme to available to new Palliative Care Nurse Specialists across LLR.