Simon Archer is a Registered Nurse. He works with the Marie Curie Palliative Care Rapid Response Team, one of the new services established in Lincolnshire under the Delivering Choice Programme. This is a community initiative, based at the Pilgrim Hospital, Boston, Lincolnshire.
3.00 pm
My day starts when I arrive at the out-of-hours office in Boston. Today must be a lucky day as I found a parking space straight away.
I check the answer phone for any messages left since 7:15 am, when the night shift went home.
Today, there is a message from the Discharge Community Link Nurse, Caroline Boyer, who is also part of the Delivering Choice Programme. She works to accelerate the discharge of palliative care patients and we support her work by visiting patients at home if needed.
My first visit today will be to a lady who was helped home by Caroline. She has heart failure and has reached the stage where she now needs palliative care. Thanks to Caroline she has been discharged from Pilgrim hospital today to spend her remaining time with her family, which is her wish.
Before I leave I am phoned by the Palliative Care Co-ordination Centre, another Delivering Choice Programme initiative, which co-ordinates the booking of home care across Lincolnshire. The Rapid Response Team often steps in to help provide care and assistance co-ordinated by the centre. In this case we are asked to contact a few patient families to explain that if they get into any difficulty or need help or even advice and emotional support, they can ring us at any time during the night.
Often the most important aspect is that the patient and their family feel they are not alone and if anything did happen they always have someone to call on.
4.00 pm
I make my way to see my first patient and on arrival I am greeted by her husband. I explain to the patient who I am and the service we provide; she is very tired after her trip home from hospital and is in bed, so I give her the medication she needs and leave her to rest.
Afterwards I spend a while talking to her husband about what to expect as his wife’s condition deteriorates. Sometimes a large part of my visits can be spent giving reassurance to family and carers so they feel more confident in looking after their loved one.
5.30 pm
Now back in the office I log all the details of the visit onto the computer system and fax the patient’s GP and District Nurse to keep them informed. We always work closely with other health professionals to make sure we provide the best level of care possible.
6.00 pm
It’s now time for a bite to eat, so I head off down the canteen. However, halfway through my meal my phone goes off. It is a gentleman who needs help because his father, who has lung cancer, is short of breath and very anxious because he does not want to be admitted to hospital. I decide to attend the patient straight away. My scampi and chips will just have to wait.
7.00 pm
I arrive at the patient’s house and I am welcomed by his son. He fills me in on what has happened and then I see his father. Remarkably, he is still making jokes and trying to make light of his situation, explaining to me through gasped breaths that he needs to be seen by a vet and put down.
I use a nebulizer to help him with his breathing and he seems to calm down just having someone there with him. I also run through some breathing exercises with him and remind him he can call at any time.
8.30 pm
I see two more patients in their homes this evening; one needs a dressing to an injury changed every evening so I know her quite well, and another has bowel cancer and is confused with his medication, so I talk it through with him and make sure he is at ease.
10.30 pm
I make my way back to the hospital, where I hand over to the night shift and log all the details of my visits and phone calls and update the patients’ GPs and District Nurses.
11.00 pm
Finally I head home after a long and busy shift, for a well-earned cup of tea.
