Caring on the frontline during Covid: Community Clinical Nurse Specialist

We caught up with one of our frontline workers, Jane Osborne, who is a Clinical Nurse Specialist, to hear from her about what it has been like working during the coronavirus outbreak.
Jane Osborne
Published on: Tuesday 02 Jun 2020 at 23:06

Jane Osborne has worked for St Clare Hospice for five and a half years. Jane is one of our Clinical Nurse Specialists and is part of our Community Palliative Care Team. The team has continued to work to support patients and their families throughout the coronavirus outbreak, adapting their service to ensure the safety of our staff, patients and their families at all times.

As part of Jane’s role she works closely with families, local GPs, community nursing teams and other health care professionals. Jane helps patients their families and carers, by advising on how to manage any symptoms they may experience, and signposting them to other services that may be helpful.

Q: What changes have you seen in your role because of Covid-19?

A: It’s just so bizarre – because we see people from the beginning of their palliative journey so we first encounter people when they are still quite well and we support and care for them through to the end of their journey. At the moment we are walking into their homes and although they are in good health we are walking in with the full PPE on and it can be frightening for them, because they can see what is coming. What they could be facing if their condition deteriorates quickly.

When someone is first told that they have a life-limiting illness it can be a very scary time and people need re-assurance and support to come to terms with their illness. When they are faced with us, in our PPE, I can’t help feeling that it makes the whole situation more scary for them. I can see that they are frightened when I walk in and it presents another barrier to the person-centred care that we like to deliver.

I know that working in this way can be very scary for the patient. The current situation has forced our care to become very clinical – we have to keep a distance from our patients, and their family members, whereas before I would use touch to help comfort or I could hug someone if they were upset; now we try not to touch anyone and try to maintain social distancing, where possible.

We’re all about touch and showing how we care and there is a barrier now.

It’s so hard as well because the patients and their families can’t see our face, so they can’t see that I’m smiling at them – I try to show it in my eyes. So much of communication is done through the face and you just don’t realise it until you’re all covered up but I try to make up for it by just being honest. I go in and say, ‘Hi, I’m Jane, and this is hard for me dressing like this, not being able to hold your hand and for you to see me smile at you’ and I sit so that they know I am listening to them. I think that helps them to understand that I’m still there for them; that I’m a person who is connecting with them, even behind the mask. I was visiting a patient the other day and a family member just broke down, usually I would have given them a hug, and I couldn’t. That was hard. But I told them that, and I gave a virtual hug – I just held out my arms – 2 metres away – and smiled with my eyes. I got a virtual hug back too! We’re finding new ways of showing that we care.

‘Our care has never been more important’

It’s difficult now, as when we would first meet someone we would usually run through all of the services that we can offer them – from Day Therapy group sessions, physiotherapy to help them live well with their condition, psychological support from our patient and family support team etc. And although we are still offering many of these services at St Clare – it is via phone contact, which again is another obstacle and not nearly as personal for people at a really difficult stage. This is the same with other community services that we would usually refer to. And to be honest, people don’t want to be travelling to access services either, even if they were running – which makes the role of the CNS so much more important. Even though we are behind a mask, we are someone who has come in to their lives, at a time when most of us are seeing so few people, and we can help them – even if it’s just a little.

We’re seeing this with our telephone calls as well, more people are calling and when they are calling they are wanting to talk for longer. Because we offer advice to everyone living in West Essex we are often getting calls from very anxious people who just need to talk to someone. It can be quite overwhelming when you’re the only one in the office – but we’ve been working as a team and supporting each other to take over calls, to make sure that no one has to wait too long to talk to someone and get the support they need.

Q: Have you found yourself working in a new way?

A: Life has changed for us as nurses as well. We are used to coming back to the office and reflecting on our experiences with other nurses, to gain support. We aren’t doing that at the moment. On the days when I am in the office, covering the advice line, we only ever have a couple of other people in our spacious office – due to social distances. And the rest of the time we are working from home and visiting patients in their homes when we need to.

As a nurse, I take on the anxieties and pain of my patients and where we are now walking into situations where our patients are more fearful it makes it more difficult for us to process once we leave them. You take a little bit of their pain with you.

I find it hard too. I still have my daily meetings with my managers and supervision, which help me to reflect and process these feelings, but I miss being able to talk over these things with my colleagues.

I really miss the face to face contact with the nurses on our Inpatient Unit too. We usually would meet with them and discuss different patients we are working with, who they might know from previous stays on the Unit for symptom management.

We’ve all been missing each other and it’s not until something like this isn’t there that you realise how much you value just being able to see and talk to your colleagues. Understandably we have had to change the way we support each other – we now have daily meetings on TEAMS and we also have team whatsapp groups, so that we can give each other support and encouragement. And it’s been amazing to see us coming together as a team to support each other with offers of shopping etc when some have been self-isolating etc. We’ve grown close in a different way and I don’t think this will change once the pandemic is over.

‘it’s been amazing to see everyone pulling together’

I’m just so proud of everyone at St Clare for the way they have accepted the situation and just got on with it. Yes, it’s been hard, but we are rising to the challenge – each and everyone one of us is pulling together to keep delivering compassionate care, with a smile.

I’ve been blown away by my colleagues in the Hospice at Home team and on the Inpatient Unit; I’m so proud of them for carrying on so brilliantly.

But it’s not just the nurses and doctors either, it’s everyone at St Clare – the administrators, the housekeepers, the chefs, the facilities team – everyone is still coming to work with a smile on their face and pulling together. It’s just been so amazing to see everyone pulling together and I’m so very proud to work at St Clare Hospice.

As a nurse, I’ve been blown away by the fortitude of our inpatient staff. I find it difficult sometime working in the PPE equipment, when it’s hot the visor gets steamed up and I can barely see and it’s so hot in it all as well. I’ve left patients and I can’t wait to take it off! I can only imagine how our inpatient nurses have been feeling, working directly with patients, regardless of their symptoms, ensuring they get the best possible care when they can’t even take a sip of water without disrobing.

Although it’s so very difficult to work with the PPE on, I’m so very grateful that we have it.

We’ve very lucky at St Clare that so many people and organisations in our local community have been so generous, making and donating masks and scrubs for us.

Our leadership team have prioritised keeping us safe with the right equipment as well. I’ve always felt protected and this helps me to know that I’m able to do my job properly without putting others at risk.

But everyone has just been getting on with it, and doing their best, and making sure that people who are at the end of their life continue to get the best care possible.

Everyone has been amazing and it makes me very proud to be part of such a wonderful team.
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