Louisa Ingham is a Nurse Practitioner at Otago Community Hospice and a member of the Palliative Care Nurses New Zealand Committee. Here she shares her reflections on trying to communicate with her patients within the context of Covid-19.
Many of us who work in healthcare are currently facing an unprecedented situation. Covid-19 has affected every aspect of our lives. Our movements are restricted, our contact with loved ones limited. Many are trying to balance home schooling children or family job losses with our own work commitments. But for those of us who work in palliative care, we face an added uncertainly. How do we support our patients and their whānau who are facing death in this strange new isolation?
We all have stories to share from this time. Patient’s separated from loved ones due to visitor restrictions in hospital or aged care. Patients who are dying alone or with just one family member present. Loved ones trapped overseas, now having to say goodbye over skype, not able to hold a hand or kiss a cheek one last time. No funerals, no closure for whānau.
So much of palliative care is about being with, being present, and walking alongside a family with a loved one on their last journey. Now for many of us, we face the challenge, how do we do that in this new covid-19 world? We are finding ourselves doing more of our communication by phone or telehealth. Many are expressing the challenges they face with this – the inability to pick up the nuances that body language and facial expression give. The inability to hold a hand or rub a back as someone tearfully expresses their fears as they face their own mortality. Even for those face to face encounters that are happening, they are often done in PPE, a literal physical barrier between us and the patient. Many report that even face to face, they are so worried about infection prevention (did I just touch my face?!) that they are struggling to be present and connect.
I wonder what this feels like for the patient? Alone so much now. Are they scared? Do we help when we come in with gloves and visors and masks? Or do we just make them feel more separate than they already did as they navigate their palliative journey?
I don’t have any answers to these questions but I do what I always do in my work, I think about what if I was the one on the other side of the metaphorical bed. What would I want and need? I know I would want authenticity. We can still provide that even in this new Covid-19 world. It starts by acknowledging the elephant in the room. Recognize how different and odd this is for us too. There are lots of guides and templates coming out to help which is great, but it’s important we remember to use the words that feel right and true to us. That we remember the person we are working with is an individual and use their name, listen and stay present with them. At the end of the day, isn’t that really what palliative care is about?
If you would like to share your reflections on the Covid-19 situation via our blog, please just let us know.