Caring through Covid: Palliative Care Consultant

Our community can take heart in knowing what amazing services and support they have at St Clare and we take heart in knowing that there are some amazing people out there in the community supporting us.
Published on: Friday 09 Oct 2020 at 11:58

As part of our series looking at the experiences of our staff during the pandemic, we caught up with Jonathan Riordan, Consultant in Palliative Care at St Clare Hospice.

As a consultant in palliative care, Jonathan’s role is usually split between working with patients in the community, working on the Hospice’s Inpatient Unit and working with patients with palliative care needs in the Princess Alexandra Hospital.

Jonathan is still in his first year of working at the Hospice, in his first consultant role, and what a year it’s been! Here, Jonathan describes some of the experiences he’s had whilst working on the frontline during the pandemic.

Q: How has your role changed during the pandemic?

I’ve spent a lot more time at work! My longest run was doing 24 out of 26 days – that was really tiring and felt relentless.

Our first challenge was the very basics – what PPE should we be using, where do we get it from, where do we get swabs from, how should we actually do the swabs. Lynne (the Inpatient Unit Manager) and I went over to the Princess Alexandra Hospital where we received a lot of help and advice – we spoke to Jo Ward, Associate Director of Nursing and Therapies, and that was really helpful.

Three of our doctors were pregnant so they couldn’t be in the Inpatient Unit because they were in the high risk category. Our most junior doctors were taken back to hospital because they were needed on the acute medical wards. So this left me, Qamar and Enam – this basically meant that there were one or two doctors at times doing what would have been done by five or six doctors – which was tricky. This meant that I was more centred in the inpatient unit, than I usually would be in my role; before the pandemic hit I was working on the Inpatient Unit a couple of afternoons a week – instead I was spending all of my time there.

Now that things have returned to our ‘new normal’; I’ve started to do more work in the community and I’m now back working in the hospital again. So these days I’m spending two afternoons a week in the Inpatient Unit and three days in the community. Luckily for me, I was so new in the role that I hadn’t really got used to what ‘normal’ was until it changed.

Q: How has the way you care for patients changed because of Covid?

A: I’m still trying to do the same things, but I do worry that it’s being done in a less personal way. I’d not really factored in the impact that Personal Protective Equipment would have in delivering patient care.

PPE has been a much bigger barrier than I thought it would be; I didn’t realise how much a smile helps to put patients at ease.

Nor did I realise how much I rely on it for communication and to show that I understand and empathise.  These days, I’m often left hoping that patients have realised that I understand what they’re saying, that I really empathise with what they are saying – but I do go away wondering whether they’ve taken on board that I care – I’m not sure I did this before.

When I go into see patients in their homes, it always feels more like an intrusion now. I worry whether I’ll be making people feel more anxious or worried by visiting them – thoughts like this didn’t really cross my mind that much when I wasn’t wearing the protective equipment.

I’m definitely using more technology as well – not so much in patient care, but more with other professionals to help them care for their end of life patients. We’ve been doing more video calls with nursing homes as well, trying to support their staff as much as possible.

On the whole, we’re still trying to do the same things but I do worry that I’m doing them in a less personal way.

Q: What are the challenges you face in your role at the moment?

A: One of the challenges now is trying to work out how we can best work together whilst social distancing, keeping each other safe – how we can continue to deliver high quality palliative care.

The environment in which we work isn’t as personal at the moment – the communal areas where people would have gathered, and shared their thoughts and feelings with each other, had to be removed to prevent the spread of infection. There’s no open visiting, no family spaces – all these things present challenges to keep on delivering high quality care, despite the limitations on the physical environment.

We are also now having to manage the psychological stress of patients, who feel that their treatment might have been affected because of Covid and whether it has affected their prognosis – this is an understandable psychological stress for them.

Q: How do you overcome these challenges?

A: Mostly it’s simply by supporting each other. It would be impossible for us to be unaffected by our experiences over the last few months.

The pandemic has definitely taken its toll at times; we’ve been tired and stressed, so just making sure that we’re there for our colleagues has been so important over the last few months.

I’ll be honest, sometimes it’s with varying degrees of success, but we just try to be understanding; giving each other a bit more time, space and understanding.

What has been wonderful is that I’ve found that people do understand the limitations that we’re struggling with when we’re delivering patient care. When people come in and stay in the Hospice they are aware of the context and I think they can tell that we care from our actions, I hope they can.

Q: Have there been any highlights from working during this time? What’s kept you going?

A: One of the highlights has been that I spent so much time on the Inpatient Unit that I got to see other people’s roles more closely. It gave me a chance to witness up close some of the care that our patients were getting – for example we had a lot of young patients at the time, with big families in some cases, and looking after those patients, explaining to people that we have to limit visitation, was so tough.

Seeing how skilful and compassionate the nurses can be in such sad and difficult circumstances was a real privilege and it made me very proud to be working here.

And it’s not just the nursing staff;  I was really impressed by how everyone, from nurses, healthcare assistants, housekeeping, kitchen staff, all pulled together, pushed through, and did their jobs so well in such challenging circumstances. As I was based there all day, working more closely with them than I would have done in the past, I got much more of an insight into what these people are doing and the difference that these people all make to our patients. We were all tired, stressed, anxious and frustrated – but seeing how people just got their heads down and delivered outstanding care was a real privilege to see.

Learning how supported I am in my role has been a really positive experience.

I also got a really good understanding of how much support I have around me; the hospital helped me with their policies and procedures – especially in the beginning with swabbing procedures for covid etc.

Our local GPs were really fantastic too; when we were struggling with staffing – from not having enough doctors – one of our local doctors’ surgery gave us their trainee GP for two months. This was an extra pair of hands and without him we would have struggled. Realising that there are colleagues out there in our local community who, out of the respect they have for the Hospice and Qamar, wanted to help.

I’d never encountered anything remotely like this before in my working career and it was wonderful that the Hospice directors’ doors were always open to me, and I often used them for advice or help.

Q: Is it important for Hospice staff to work closely our local healthcare colleagues during a pandemic?

A: Yes, absolutely! I think it’s important for so many reasons. We need their help; partnership working is important at all times, but Covid has made us understand that importance more. We’ve had great support from the Princess Alexandra Hospital, our local GPs and working with our colleagues in EPUT  (Essex Partnership University NHS Foundation Trust). It’s been so helpful for us working more closely, but we know that they also need our help too. We have expertise at delivering care quickly in the community and it’s important that we give our healthcare colleagues our advice and experience as well.

Our patients want and deserve joined up services and we can only achieve that if we work together. Covid helped to break down some of those organisational barriers, which can only lead to better clinical care for our patients. Most of our senior Doctors work across sites and this helps us understand the wider healthcare landscape; visiting care homes – offering advice and training, meeting with GPS to discuss their palliative care patients and regular meetings with EPUT and the West Essex Clinical Commissioning Group (WECCG).

Q: What have you learnt from working during a pandemic?

A: Don’t take anything for granted, I probably took too much for granted.

People can be really amazing when they need to be – I probably knew that before, but the pandemic has really made me realise this.

I think for me, the biggest lesson is actually how important it is to look after yourself if you are going to be strong enough to look after others; physically but also emotionally. I now know that I need to make sure that I’m looking after myself properly.  This is the first time in my career that sometimes I got home and I felt like an absolutely mess, and I know it was because I wasn’t taking enough care of myself – it’s easy to burn out that way.

All in all, it’s been a tough few months and a steep learning curve for my first 9 months as a consultant but I’ve taken a lot of positives away from the situation as well. Firstly that the care that we provide here is truly outstanding and I couldn’t be prouder of that. Secondly it was really nice realising how much support I’ve got around me, whether that’s the nurses on the unit or in the hospital, the senior leadership team, or our GP colleagues, ready to step in and help when we needed them. And that makes me confident that although the next few months aren’t going to be easy, we’re in a good place to cope with whatever is thrown at us.

Q: What are your thoughts about a spike in cases and how well the Hospice will cope?

A:  It’s natural to look back and ask yourself what you could have done differently. But it’s really important to remember that the first time round everything was new to everyone; we went from one day knowing that it existed to then having to develop policies on how to run a Hospice amidst the pandemic. We were working at a stage where the Government was giving briefings in the afternoon and we were having to have policies in place for the following morning. Absolutely hats off to our Senior Leadership Team, who managed this so smoothly!

We know that it’s not going to be an easy few months coming up. But one of the advantages of staying open as an Inpatient Unit is that we now have this wealth of experience going forward. So for us, the second time around, the difference is that we have things in place already, rather than creating new ways of working and guidance for staff, whilst delivering patient care.

It’s incredibly important to show how resilient as a community we can be, continue to take heart in being kind to each other.

Throughout the pandemic, people have shown amazing acts of sacrifice and selflessness and I’m sure that will continue. I just also hope that people realise this time round what a psychological impact another wave will have. Last time people were worried about the logistics, and I don’t think people were prepared for the psychological impact. If people are aware of this, then they have a better chance of looking after themselves and looking after each other.

 – Jonathan

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