Every day is different, but here's a glimpse into one of Hospice at Home nurse Karen's typical shifts.

8.30am At home I turn on my laptop so I can check through the emails from last night’s calls and visits, to see whether any of my patients need to be contacted urgently. Sadly, one of my patients died overnight. I call the family to say I am so sorry and ask how they are. They report that he died peacefully and comfortably, with family present; I arrange to call his wife again next week.

9-10am I make calls to patients and a local community matron. A patient has deteriorated since yesterday, her husband is very upset, I offer to visit.

Nurse Karen10am I leave for visits. At each home I wash my hands and don PPE. On leaving, I remove and dispose of PPE and wash my hands again.

10.30am A pre-arranged visit to review a patient who is becoming more fatigued and to chat with him and his wife. We discuss whether I should refer him to our therapists, to assess him and perhaps arrange equipment to make him safe and more comfortable. He says that he would prefer to spend more time in bed, where he is most comfortable. He can be in the heart of the home as we have set up a special bed downstairs. I review his pain medication, and offer help with care, but he wants to continue caring for himself. Before saying goodbye I ensure that he and his wife have our contact numbers should they need us.

11.30am At the next patient’s home I am met at the door by the husband, who is very worried. His wife is very frail and pale and does not wake when I assess her. There are no signs of pain or distress. Her breathing is shallow and slow. We talk in an adjacent room. The patient’s husband thinks his wife is dying. I agree that this seems to be the case. We talk about how she will get comfort from having him nearby, hearing his voice and feeling his touch. He can read to her and play her music. We discuss support for him – his daughter will arrive soon. We talk about signs, like frowning or crying, which could indicate pain or agitation. There is medication in the house and we could arrange for a nurse to visit. The GP saw her yesterday, they have carers coming in to help. I will call again tomorrow.

12.30pm I get in the car and head back to the Hospice for lunch.

1.45pm I check my emails and respond to calls. I ask the local district nurses to make sure they are aware of the changes to the last patient. They have scheduled a visit today.

I make calls to four of my patients or their relatives, to ask how they have been and arrange subsequent calls and visits. I email a patient who has a tracheostomy, and is unable to speak on the phone. A GP calls to tell me that a patient is deteriorating and needs to be seen urgently. I call the patient and her daughter and arrange a visit this afternoon.

3pm I complete a fast-track application for one of my patients who needs urgent care at home. This requires completion of three documents, which are downloaded onto a secure portal.

4.15pm I leave the Hospice for a patient visit.

4.30pm On arrival, I greet the patient and family. I first met the patient, who has lung cancer, a year ago. She has been well but recently deteriorated. We agree a plan for the coming months so she can stay at home, as she would like. She declines offers of carers. I call her GP and local district nurses to arrange support for the patient and her family.

5.30pm I leave and drive home before turning off my laptop.