Here at St Christopher’s, I’ve been running a Project ECHO learning community with a team of district nurses, a community palliative care team and a hospital palliative care team for the last 18 months. In normal times, we’d meet via Zoom once a month to look at a relevant clinical topic, and then two people from the community would present a case study, relevant to the topic for that month.
Since March of this year, due to the Covid-19 pandemic, we put these on hold, but in the last few weeks we were delighted and so excited to restart these sessions. Whilst we have an agreed curriculum for each month, it would have felt insensitive to march on with this, given our experiences of the last few months, working on the front line during a pandemic. With this in mind, we agreed to dedicate our return to our Project ECHO community to creating time and space to reflect on our experiences of and learning from caring for people affected by Covid-19.
A key part of the Project ECHO philosophy is respecting all the skills and experience the group members have. Therefore, although the session starts with a presentation from a clinical expert and is led by the ‘hub’ (St Christopher’s), this is only to facilitate discussion between all the members of the community.
Marie Cooper (our Project Lead for Celebrating Palliative Care Nursing in 2020) began the session by spending time helping people to reflect on the last few months, and recognise the impact such dramatic work and life events can have on us all. Marie’s session provided a space for group members to begin to think and reflect on the pressures and stressors they have faced since the start of the pandemic.
“Feel the fear but do it anyway”
Following this, we listened to two case studies, the first from a team of district nurses who spoke about the care they had been required to give to a person known to have Covid-19, and be approaching the end of his life, at home. As their first person known to have Covid-19, this caused them and their team a great deal of anxiety. Concerns for their own wellbeing and that of their families and colleagues were paramount. Worries about having the correct personal protective equipment, along with how to use it caused a great deal of stress.
Mundane issues such as how to find the person’s home, and what equipment they needed for the visit, became extra challenging due to the intense anxiety created by needing visit a new person who was considered to be a high risk in relation to passing on this new disease, which no one at the time really understood.
Mundane issues such as how to find the person’s home, and what equipment they needed for the visit, became extra challenging
All that was known was that it was highly infectious, there was news of health care workers becoming very sick with it, and some cases of health care workers dying due to the infection.
The nurses shared with great humour how they dealt with the challenges they faced by working together, but also recognising the professionalism and courage which was required of them. They not only recognised the value of nurses and nursing care for this person, and their family, but also how their training and career had prepared them for this moment.
“We are in this together…it’s the only way”
Our second case study was presented by a member of the hospital palliative care team. Given the setting, the presentation opened up different perspectives, yet shared so many similarities.
The hospital team reflected on the great challenges they faced at the height of the Covid-19 pandemic. The numbers of patients they were supporting exponentially increased, and they were called upon to provide not only palliative care support to many people who were dying rapidly, but also hands on basic nursing care.
Their case study focused on a dying person, being cared for on a very busy hospital ward. Due to visiting restrictions, the dying person’s family was unable to visit and be with him as he died. The team described how they had helped this person to communicate with his relatives using their own mobile phones, and even did this with their hospital chaplain to enable the family to be part of the Last Rites.
Such intensity in caring for people at the end of life and facing such emotionally charged obstacles has had a significant impact on the team
Such intensity in caring for people at the end of life and facing such emotionally charged obstacles has had a significant impact on the team. The Project ECHO session prompted the team, and all of us taking part, to reflect on the enormity of the challenges we have faced throughout this time, and the need to pause for thought to attend to our own feelings.
Keeping it real and staying connected
In both case study presentations, we heard with such honesty and emotion the understandable sheer fear our colleagues experienced with their first, and early, Covid-19 patients and how that fear played out.
We also heard about the courage and sense of professional duty as a nurse which emboldened them to keep going in to see the people they were caring for, knowing these people relied on them.
We also discussed the stress of cognitive load and how they recognised how much they were carrying in terms of worrying about their own family, which was constantly in the background as they faced the day with their ‘work head’ on, only to find more stressors in having to deal in the moment with new challenges.
Key Reflections for me
Both case study presenters identified a number of factors which helped them, and continue to help, as we attune our practice to a new normal. As a consultant nurse working with a large team of nurses on the front line throughout this pandemic, I certainly share these, and the Project ECHO session helped me to reflect on my own story.
These factors were, the importance of support from our colleagues and team, feeling ‘safe’ to be vulnerable and to be able to ask for help. Everyone recognised that as we progress through the pandemic, we gain more knowledge and expertise in providing care and support to people affected by Covid-19, which also spoke of our increasing confidence in using personal protective equipment.
Most importantly, and I can certainly vouch for this in my own work, and personal life, the thing which has really carried us (and me) through this time has been the ability to still find humour in our work and lives.
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