Karenne, Manager of Hospice at Home Team
“I wasn’t prepared for how rewarding the role is and how much I would love it” 
Palliative care is a very new specialism within the medical and nursing world and involves caring for patients that have life limiting illnesses. At Rowcroft we care for those patients who may be experiencing difficult symptoms or emotional distress that need the input from a specialist palliative care nurse or doctor.
The role of the hospice has changed in recent times, we don’t just sit and hold people’s hands as they die. Our focus is now on helping patients to continue to have a good quality of life for as long as possible using various therapies and medications. We do still care for patients right at the end of their life too and then our focus is on trying to provide the environment that the patient has stated that they wish, this may be at home or within the hospice.
I joined the hospice as a clinical nurse specialist (CNS), I managed a caseload of patients that had been referred to the team for support with symptoms or advanced care planning or emotional difficulties. Communication was vital, without knowing what the patient wants you can’t help them! It was so good to get the feedback from a patient that I had made a difference, that the patient was now able to do the things that they wanted to achieve because they no longer had the disabling symptoms that they had when they were referred. As a CNS I did the non-medical prescribing course which gave me the skills and knowledge to prescribe the medications that the patients needed. I was an autonomous practitioner, and it made my role easier but also gave confidence to patients and families that I knew what I was talking about. Patients were able to ask more questions about their medications and were able to access the treatments that much quicker.
I am now the manager of the Hospice at Home team, and our focus is different. Our patients are at the end of their life, and we manage symptoms and distress to ensure that each of our patients achieves a ‘good death’. A good death may not be the same for everyone and it’s only by talking to patients and families that we find that out. Caring for a loved one at home when they are dying is scary, emotional, sad and confusing, our team are there to try and take the burden of that care away from the family (if that’s what they want!) and allow them to be loved ones and not carers. We give them a single point of contact so that they don’t have to worry about who to call and respond as quickly as we can.
I came into palliative care not really sure that it was what I wanted to do but had had previous experience of palliative support (as a family member) from another charity so knew that families and patients needed it and were grateful for it so wanted to give it a try and give something back. I wasn’t prepared for how rewarding the role is though and how much I would love it. You only get one chance to get it right – people only die once and when you get it really right you can walk away feeling on top of the world. You’re sad because someone has died but when you’ve been with the family who have been able to express their love for the person dying, and you know that the person has died peacefully in the place of their choice despite the symptoms that they may have experienced a few days before it is so rewarding. We are seeing patients with really complex symptoms now, patients that just a few years ago were being treated and dying in hospital. Thanks to levels of skill and knowledge that we have attained we are now able to care for these patients in their own homes or on our inpatient unit. We as nurses make decisions about treatments and medications. We are probably the highest prescribers of morphine, a drug that is so scary for a lot of healthcare professionals, but we use it with skill and titrate doses to ensure that patients are as pain free as possible without side effects.
Working in the community enables us to work alongside all the other community teams that may be involved in a patient’s care, we are a huge team with slightly different responsibilities but can learn from each other and most importantly support each other.
Palliative care is, for me the most rewarding specialism of nursing, but don’t just take my word for it. Come and spend a day with us, see what we do, the hospice is so much more than just dying.
