Using clinical and human skills to meet patients’ needs as early as possible
With her family history, it would be hard to imagine Helen not becoming a nurse. She is the latest in a very long line of nurses, midwives and medics, which includes one of the very first midwives in Wales and, going back further, medics involved in the first vaccinations for smallpox in the 1700s.
Helen’s journey into nursing started young too. As a six-year-old she’d visit her grandmother who worked at the School of Nursing in Cardiff and attended lectures.
Equally, it was early in her training that Helen realised that her future lay in palliative care. “I’d notice on ward rounds how people for whom nothing more could be done would be avoided and ignored. They were not managed well, and often became very distressed and their families were not aware of what was happening. So I became interested in communication and care for the dying.”
Then, after qualifying, Helen worked on a paediatric oncology ward and was inspired by a new Clinical Nurse Specialist. “I observed her talking to patients, listening, and problem solving – being a pivotal person in their lives. I thought, ‘I Iike this’, and realised it’s what I wanted to do.”
That post was followed by ones in hospices, in the community and in hospitals and Helen has also completed her advanced nursing practice MSc. She is currently Lead Specialist Palliative Care Nurse at Velindre Cancer Centre.
Over the last few years Helen has brought her palliative skills and sensibilities to the newly established acute oncology assessment unit.
She also uses a blended approach to provide holistic patient care, being creative where there is complexity. An example of this is undertaking training in hypnotherapy and relaxation techniques which Helen has successfully used to help patients continue with treatments when their anxiety levels might otherwise have stopped them.
What drives you to make a difference?
“I was attracted by palliative care as on the one hand it is very complex clinically while on the other hand, there is the human side of personal care and finding a connection – really seeing the person.”
“I’ve always gone for jobs where there is a mix of education and clinical, which is a rare mix in nursing. It means I’ve been able to keep my finger on the pulse of the organisation, the problems on the ward, keep my clinical skills up and manage education and governance too.”
While Helen is always motivated to make a positive difference to the lives of the patients and families for whom she is caring, she has also learned through experience to know when she may not be able to make that difference.
“Achieving a good death isn’t always possible. Some people have difficult and complex lives and often, if a life has been challenging, then that person’s death is likely to be challenging too. You might be able to make some small differences, but you have to learn not to beat yourself up about it.”
How do we see the art and science of nursing expressed?
It’s in her work on the acute oncology assessment unit that Helen has found her calling and is having a real impact, becoming integral for patients at the earliest possible stage.
“Whereas previously we wouldn’t get involved until it was finally decided we were needed, now we’re on hand, making decisions from the start. We can be involved in the admission process, perhaps referring patients to a hospice or getting the community team involved. It’s removed the role of another gatekeeper who might have taken the decision that the patient wasn’t yet ready for palliative care.
We cover the assessment process so as to avoid unnecessary admission and to try and achieve patients’ preferred place of care. Very often we’re also dealing with advanced care planning which have not been addressed previously.”
The coming together of art and science is demonstrated even more clearly in Helen’s role in integrated services – linking a group of oncology nurses and the team of doctors.
“It allows me to see patients who have been on a bit of a merry-go-round. I find I am able not just to perform an essential procedure which will provide them with rapid symptom relief and prevent admission, but also get to know them as a person and understand their condition. I can introduce myself as being part of the palliative care team and start an important conversation.”
Maintaining the balance of the art and science and recognising the importance of both, is key in Helen’s eyes.
“The complexity of some of the ethical decisions and communication skills are just as challenging as some clinical aspects of the job; they are both advanced skills. Looking to the future we should see what we can offer in terms of acute management of palliative patients, but we should not ignore what is our bread and butter and at the heart of what we do – which is still care of the dying.”
How can nurses strengthen their leadership and impact?
Helen is convinced that palliative care nurses have much to offer their colleagues in other disciplines.
“I think they can really learn from us. In particular, communication skills and going in with the approach that the patient is at the centre of everything. That means always being aware of their thoughts and wishes and planning from there, rather than looking at lines of treatment.
We often bring a lot of common sense, a wider view and willingness to open difficult areas of discussion.”
COVID-19 has only served to emphasise the need for the palliative approach nursing, Helen says.
She adds: “COVID-19 has shown us how important it is to look at the whole person. If you don’t then you won’t ever achieve the outcomes you want.”
To that end, Helen is an advocate for a new approach that could see patients’ personal needs and wishes becoming better integrated into their care at an earlier stage.
She says: “There is a lot of talk here about palliative acute assessment units and I think there may well be a role for these alongside a hospice unit.”
Helen is also adamant that there is major role for senior nurses in palliative care. “In terms of the development of advance nurse practice and consultant nurse roles, this is an area palliative care should definitely not get left behind in, just because some people see what we do as being touchy feely.”