Louise Parkin is a specialist respiratory nurse in the trust’s Hospital at Home team – an innovative service which cares for patients with chronic obstructive pulmonary disease (COPD) in their own homes.
It is run day to day by a team of specialist nurses and physiotherapists and overseen by consultant physicians Catherine Monaghan and Julia Dunleavy.
Anyone with COPD can be referred into the service – initially through their GP or health professional but then they are able to contact the service directly for help and advice or to request a home visit.
Louise’s day starts at around 8am when she arrives at the team office at the University Hospital of Hartlepool. From there she logs on, meets with other staff in the team, plans in any patient visits for that day – though many are also unplanned – and makes any calls she needs to before heading out into the community.
Every day one member of the team has responsibility for linking in with other team members and receiving any new patient referrals, while also carrying out patient visits.
Over the course of the day she visits five patients – a relatively low number, considering some days it could be at least double that.
As we drive to her first patient appointment, Louise says: “I always thought I would be a hospital nurse because I found the role so rewarding. Now I’ve tried this, I can’t see myself doing anything different. In this team you get to spend more time with patients, we have the time to be there for them and to pick up on issues and deal with them. We have the chance to make a real difference over an extended time. It’s very different.”
“Do you find you cough more at night than you do during the day? I think we need to have a look at changing your inhaler. And how has your eating and drinking been lately?
“Can I ask you to hold your arms out and to close your eyes? And can I check if your ankles are okay please?”
After a few more general queries, Louise is getting ready to leave.
“So we’ll come and see you again on Thursday and have another look at you. I’ll drop your GP a note and ask for a change for your repeat prescription for an inhaler”, she says.
It’s visits like this that have helped the trust cut hospital admissions by around 20% in the service’s first year. Nurses are usually able to provide the care in a patient’s home and help with any issues there and then.
The next patient is a man in his 50s who continues to heavily smoke. He is also alcohol dependent, something which can make treating him even more challenging.
Louise says: “We have told this patient that we are reaching the point where we are running out of options to help him. But he still continues to smoke and his condition is deteriorating. There are also challenges around his drinking – for this reason, we would normally try to visit him in the morning rather than the afternoon. We can offer guidance and advice but if patients don’t follow it we are limited by what we can do. This particular patient is sometimes not even at home when we visit, which is clearly very unhelpful.”
It’s just one of the many challenges the Hospital at Home team have, but is also part of the variety which makes the role so interesting and rewarding.
Louise says: “In this role, when you knock on a patient’s door you’re never quite sure what to expect on the other side and that’s the challenge of it.”
Louise’s next visit is to see 84-year-old Norma, who was referred into the service from a hospital clinic.
She said: “The service is fantastic. The team are very impressive and have always been available for advice or help when I’ve needed them.”
She is one of many success stories.
After a brief trip back to the office to see members of the team and make any enquiries, Louise heads back out to her next patient.
Fred is a 79-year-old man who’s been using the service for several months.
Louise says: “Fred gets breathless and, unfortunately, he does continue to smoke.
“It usually takes him all morning to pull himself around so we would normally visit him in the afternoon.
“Like many of our patients, one of Fred’s issues is he gets anxiety when he gets breathless which makes it worse. We try to teach our patients diversion techniques to distract them – even something like counting the patterns on the wall – helps break the cycle.”
Louise’s next and last patient of the day is an 86-year-old lady, who is an example of the many different challenges the team can face.
Louise explains: “This lady was recently discharged from hospital, where she spent time being treated for pneumonia. She is 86 and very frail now, god bless her, so that’s why we need to put a plan in place for end of life care while she is in a position to express her wishes before it’s too late for her to do so.
“We need to speak to the district nursing team and arrange for them to make a home visit and get to know her, ahead of end of life care.”
One of these issues is around the patient’s consent to do not resuscitate. Otherwise known as a DNR, this is a legal order to withhold resuscitation if the patient’s heart were to stop.
Afterwards, Louise says: “It’s really sad to see patients who we can no longer help. But the positive thing is we are able to help patients like this and make whatever time they have left as comfortable as it can be.
“It’s just another reason why this is the most rewarding role I’ve ever had.”