Nele Bohn, Ward Sister at ellenor’s inpatient ward (IPW), always knew that nursing was for her. But it wasn’t until her first placement, treating patients with cancer on an oncology ward as a student-nurse, that she saw a “different side to nursing”.
“The focus wasn’t just on getting people better, but also ensuring that they had the quality of life – if not the quantity. I realised that this is something I wanted to do with my life and career. Palliative care was the one for me – I liked it from the start”.
Nele, then, was a perfect fit for ellenor. The Kent and Bexley-based charity supports patients with life-limiting illnesses both at home and from its Gravesend hospice. On the in-patient ward there, Nele’s role (while involving some aspects of management and administration) is predominantly clinical – something that she wouldn’t change for the world.
“It’s an honour to look after patients at the end of their lives. No one else has that particular privilege, do they? Being with someone when they’re dying. We make it as personal as we can – focusing on their comfort and dignity and respecting their wishes”.
As Nele acknowledges, though, working in a hospice isn’t for everyone.
“I think you either love it or hate it. On a daily basis, you’re being confronted with the reality of death. You feel how precious life is, really. So, on a mental level, it is quite challenging”.
A key part of this challenge, Nele explains, is tackling some of the common misconceptions around palliative care.
“When you tell people what kind of nursing you do, they go “oh, that must be really sad”, or “this must be very hard for you”. You try and tell them it’s not actually all doom and gloom, because that’s what people associate end of life care with – that it’s grey, that it’s sad. That it’s all about death.
“But it isn’t, actually – it’s the opposite! It’s about life, and making sure the people we look after can enjoy the time they have. People don’t always understand what hospice care is about. We’re not just here to care for the dying, but to ensure that they have a good quality of life, too”.
And, as Nele adds, the patients occupying the beds of ellenor’s IPW “don’t always come here to die. They come to have their pain sorted out; to ensure that they’re comfortable, and that their symptoms are managed – or, to ensure that the right support is in place at home to meet their needs, and that of their family”.
ellenor’s care, after all, is holistic. Rather than treating just the condition, the hospice’s ethos is to treat the person. “It’s not always about the patient’s prognosis, but the other parts of their life that have been affected by the initial diagnosis of cancer, or a life-limiting disease”.
To do this, Nele and her nurses work with a range of doctors and nurses, as well as ellenor’s Hospice at Home team in the community. The IPW also maintains close relationships with ellenor’s wellbeing team – which encompasses services such as spiritual care, in addition to occupational and music therapy – on a daily basis.
“Some patients are scared of dying, and it all just needs exploring. We don’t concentrate solely on their physical needs, but their emotional and psychological needs, too”.
ellenor’s in-patient ward has remained open, with visiting in place – even if only for those at the end of their life – throughout the coronavirus pandemic. But how has COVID-19 changed things for Nele’s team?
“It’s highlighted the need for intimacy and closeness, as well as the importance of personal, face-to-face care. While we’ve all realised we can do a lot with Zoom, nursing is one thing you can’t do with a computer. You can’t look after a patient through a screen”.
The pandemic-enforced move to increased PPE use and restricted contact with loved ones, Nele believes, has also reaffirmed just how vital the human element of nursing is.
“Contact with other people is something the large majority or people find essential. We’ve noticed even more so in the last year that it’s really needed, and that it has such an effect on [a patient’s] emotional and mental health. Now that you have to wear gloves, and a mask – you can’t touch someone’s hand for comfort, or smile at people like you did before”.
At least, Nele explains, the support of the families – with whom the IPW’s nurses maintain regular contact – has stayed strong.
“The families are amazing. With the changes to our visitation rules, it’s been really confusing for everybody. But the relatives have been so understanding, and the gratitude is very much the same as before [the pandemic]. They’re grateful for the care we’re giving, and the contact we keep.”
This, perhaps, is one of the reasons why Nele’s outlook remains so optimistic.
“We’re getting through it, and we’re doing so by being positively minded – we can all see the light at the end of the tunnel!
“Often, a challenge has to happen before you realise what’s important in life. You look at the world around you with a different view.”