As an Out-Patient Clinical Nurse Specialist, Teleri’s role is to support people who are referred to the Hospice because they have a life-limiting illness and perhaps need support with specific symptoms, but do not yet need the focused and ongoing care of our Hospice at Home team or In-Patient Unit. Here she recalls the way the COVID has affected her work and the way she communicates with patients.

Nurse Teleri“I’d only been in my role for a few months when the COVID pandemic started to impact on the Hospice in a big way. Until then, I’d met most of my patients face to face at local GP surgeries. In March 2020 this changed very rapidly and as lockdown took effect, patients were offered a video call or telephone call instead. This wasn’t unique to my role – many of my colleagues including doctors, other nurses, physiotherapists, occupational therapists, social workers and many others were taking the same approach.

This was a big step for everyone involved – not just for the patients but for me too – I’m definitely not a technical person and had never used Zoom or anything like that before COVID. I missed some Zoom training at work due to an appointment so I figured it out myself at home, like many people did back then. Some patients were apprehensive, but during full lockdown face to face meetings were just not possible, so many people gave it a go.

Quote: I had never heard of Zoom of how to use it, but it is so easyThe Hospice trained up a team of technology volunteers to support any patients or family members who might need help getting started with Zoom, but research has shown that actually, for many of our patients, technical problems weren’t really an issue at all, which has surprised many of us – in a good way of course.

As time went on, we started to get used to video calling and feel comfortable with it. Of course, it was not without its challenges and I did find that I needed to employ slightly different communications skills and adjust my radars to ensure I was picking up as much information, verbally and non-verbally, as I could. I started to recognize that it actually had some important benefits as well. When many patients (and carers) felt extremely isolated, seeing a friendly face on a screen could be very reassuring and a welcome change. Meetings could be organized at very short notice if required.

It also became apparent that by using Zoom, we could allow others to be more involved. We could extend the invitation to family members if this was what our patients wanted – not just partners and carers but also sons, daughters and other relatives. For much of the last year or so, they couldn’t visit their loved one due to travel restrictions or shielding measures and in many cases would find it difficult to attend appointments even during ‘normal’ times, because they didn’t live locally.

A remote consultation taking place via laptopWe could also take an even more multi-disciplinary approach than usual, thanks to Zoom. I’ve been able to run Zoom meetings with not just me and my patient and their family, but also other colleagues from the Hospice and specialists from other organisations. On one call I was hosting I had a couple here in Surrey, their daughter joining from overseas, and the patient’s specialist joining from St George’s Hospital. This kind of joined-up approach can be so beneficial in terms of the care provided and can really provide invaluable reassurance and peace of mind.

I know some of my colleagues at the Hospice also found this to be the case when supporting patients who are residents of local nursing homes during lockdown, as they could have Zoom calls with the patient, their carers at the nursing home, and family members as well, who again would be unable to visit in person.

Looking back on the last year or so, it’s obvious to me that remote consultations by both Zoom and by telephone have played a major part in ensuring that our compassionate care has continued. The Hospice at Home team have completed nearly 1,000 Zoom consultations and many more by phone, and the Wellbeing team have delivered nearly 4,000 sessions via a weekly timetable of Zoom groups.

1,000Hospice at Home team Zoom consultations

4,000Wellbeing Centre Zoom sessions

80%of patients surveyed would recommend the use of video calls to others*

As a research active organisation, the Hospice team has also conducted and published a service evaluation on the use of video consultations during the COVID-19 pandemic, which we share with the aim of improving palliative and end of life care for everyone.

As guidelines change, I’ll be able to see more patients face to face, but I’m still very much offering Zoom as an option. It’s not for everyone and not for every occasion, but it definitely has a part to play and can be not just convenient but also a positive way of making communication, and the care I can provide, even better.”

 

*Milne S, Palfrey J, Berg J, et al

Video hospice consultation in COVID-19: professional and patient evaluations

BMJ Supportive & Palliative Care Published Online First: 23 June 2021. doi: 10.1136/bmjspcare-2020-002861