There is considerable national debate about how patients and their loved ones want care to be provided with compassion, kindness, dignity and respect – no more so than at the end of life.
At Worcestershire’s St Richard’s Hospice these values are well established and reflected in everything they do, says Care Director June Patel.
“Our approach to care is inspired by the founder of the hospice movement, Dame Cicely Saunders who said “you matter because you are you. You matter to the last moment of your life and we will do all we can, not only to help you die in peace but also to live until you die.”
One area of the hospice where these values are clear to all is the St Richard’s In-patient Unit (IPU) at Wildwood Drive in the city.
Patients and their loved ones often arrive at the hospice very anxious and in pain and can be surprised at the joy, smiles, laughter and warmth they find which goes hand in hand with the excellent specialist palliative care.
They are welcomed into patient bedrooms which are comfortable and homely with ensuite bathrooms and a private patio area with views to the lake and gardens. Meals are all prepared and freshly cooked in the hospice kitchen with plenty of variety on offer to tempt different appetites.
Having family and friends around is often important to the patients. At St Richard’s there are no limited times, visitors are welcome whenever a patient wishes. There are also two guest rooms where relatives may stay overnight to be near their loved ones or a bed can be put up in the patient’s own room.
The IPU was expanded and the layout changed earlier this year in a £1.4m project which included building four new bedrooms. This means St Richard’s now has 13 single rooms and two shared bedrooms offering greater privacy and dignity to patients and families. It is expected the changes will increase the number of patients being cared for by 20%.
St Richard’s provides care to people whose illnesses are no longer curable and who have symptoms that need specialist support. While some people going to the IPU may have only a few weeks to live, others may have many months or even years to live. Often people believe that patients only go to St Richard’s Hospice to spend their final days. However, although providing dignity and support in those last days is an important part of St Richard’s role for some people, in fact many patients are discharged from the hospice. For example in the last year 111 patients spent a short time at the hospice, for reasons such as help controlling their pain, and then went home or to their place of care such as a nursing home.
The care in the In-patient Unit is best described as ‘whole person’ care, aiming to achieve the best quality of life for patients and their families. The staff aim to respond to all the needs that a patient or their family may have – whether that is pain and symptom control issues, physical problems or issues of a spiritual, emotional or psychological nature.
During a patient’s stay they will be cared for by a team which includes the Family Support Service. This team offers a specialist service to patients and families including social work, support for children, group work, counselling and citizen’s advice. Patients can also been seen by chaplain’s, occupational therapists, physiotherapists and complementary therapists.
The IPU runs 24 hours a day, every day of the year and patients and their families are cared for by a team of health professionals led by the Medical Director and Consultant in Palliative Medicine, Nicky Wilderspin and the IPU Manager, Fiona Howarth.
Dr Wilderspin has worked at St Richard’s for the last two years and previously built a close relationship with the charity when she was Consultant in Palliative Medicine for the community NHS Trust, based at Worcestershire Royal Hospital for five years.
She said, “We are very keen to hear what our patients and families think of our care, as we are always striving to improve.
“The feedback we receive underlines the value that patients and families place on dignity, comfort, care and support. They often mention how important it is for them to be treated as individuals, where their own particular needs and preferences are acknowledged and supported. They often say how it is the attention to detail and the ‘little things’ that can make all the difference to their experience of care.”
Those ‘little things’ vary enormously from person to person. For one patient it may be having their devoted dog stay with them in their room, for another, having a family party at their bedside or simply sitting outside in the sunshine.
Dr Wilderspin added, “It is a privilege to be involved at such an important time in the lives of our patients and families. There is so much that can be done to provide support in difficult circumstances and hospice care enables us to address the holistic needs of each patient – whether they be physical, emotional, psychological, spiritual or social. The beautiful environment at St Richard’s and the time given to offer detailed assessment gives us unique opportunities to focus on the individual needs of our patients and families in a supported setting.”
The In-patient Unit is staffed by a dedicated and skilled nursing team with a high ratio of nurses to patients. They are often asked how they feel about working in a hospice environment.
“Being part of a team that provides excellent care is extremely rewarding but we do also recognise the stresses that our staff can experience, “ said Dr Wilderspin.
“Effective team work is one of the foundations of good palliative care. Our volunteers and staff acknowledge their different strengths and have mutual respect for the complementary skills they bring for the benefit of patients. Good leadership and staff support are important and examples of this range from team meetings with all the health professionals involved with a patient’s care, to an informal chat over cup of tea at the end of a busy day.”
Excellent feedback is also a good motivator to staff and volunteers.
One recently comment included: “Your team thought of everything possible to ensure that he had the best possible care and that of course included his family and friends who visited him. It is a rare gift to be able to discretely nurse a patient so that he is enabled to present himself in the best possible way and enjoy his last remaining days with dignity and grace. Without doubt, your team have this wonderful gift in bucket-fulls.
“Whenever I visited, he told me just how marvellous the nurses were to him. They all were so kind, cheerful, immensely caring to all of us. Congratulations to you all, your team are achieving perfection – and I do mean perfection – in your standard of care offered to those who are fading from us and to those who must watch and mourn and making end of life care so dignified, uplifting and serene.”
Many of those who fundraise for St Richard’s – which is an independent charity reliant on donations – are those who have loved ones supported by the hospice.
Among those who took part in the recent St Richard’s Waterways Walk were Mo and Andy Usowicz from Bewdley, taking on the challenge in memory of their daughter Nikki who was cared for by St Richard’s in her final days.
Mrs Usowicz said, “St Richard’s Hospice holds a special place in our hearts. Nikki, our daughter, had breast cancer that had spread to her liver and bones. But Nikki wasn’t going to give up without a fight, she had two teenage daughters and a gorgeous granddaughter, and decided to cram as much as she could into her life. Nikki took part in three sponsored walks even though she was suffering from pain in her legs. She bought a Mini convertible; went to the British Grand Prix; up in a hot air balloon and saw Rihanna in concert amongst other things. She always made sure she spent as much time with her family as she could. This was very important to her. Nikki was an inspiration to all who knew her.”
Mrs Usowicz added, “She was looked after so well at the hospice, and passed away in September 2012 aged 40. We wanted to raise money for St Richard’s in memory of Nikki and to enable the hospice to continue helping others with life-threatening illnesses. Everyone at the hospice does a wonderful job. I want to repay the hospice for everything they did for Nikki, and for everything they do for other patients and their families. They rely on donations and it was Nikki’s wish that we raised money to help St Richard’s Hospice.”
In the last year 262 patients were admitted to the IPU for the first time, with the most frequent length of stay being a week.
The majority of patients seen have a cancer diagnosis but approximately ten per cent are living with other life-threatening conditions including heart and circulatory diseases as well as respiratory diseases, degenerative nervous system diseases including Parkinson’s and Multiple Sclerosis.