How Covid 19 has really challenged my ethics, morals and ways I practice

Written by Wendy Ashton, Eden Valley Hospice – August 2020

As a palliative care social worker in a Hospice, Covid 19 has really challenged my ethics, morals and ways I practice. Hopefully for the better in the long term.

I work in a small Hospice that covers a vast rural community and work as a full time Palliative Care Social Worker and Family Support Team Lead. I work with people with at end of life who have complex needs and aim to make the time that people have left as happy and content as possible. I think Hospice staff are a ‘Huggy’ lot and we work well as a multi-disciplinary team. A large part of my role involves working with families and friends as well as clients.

When Covid appeared I found myself being based on the ward in a small office wearing scrubs. We chose our own colours but the teal I chose turned out to be mint green! What a laugh. The purpose of this is to reduce footfall around the Hospice and contain the clinical staff – which I was one of – in the clinical area. It was a bit scary at first as we had to get used to wearing aprons, gloves and masks when seeing patients. It all seemed very depersonalised and a tad out of my comfort zone. The High School Musical song ‘We’re all in this together’ springs to mind frequently.

I have written about a few examples of adapting to working within Covid restrictions to share that we can still achieve person centred care in an empathetic and positive manner.

Often, a patient is too unwell to return home and chooses to die at the Hospice. A last wish is to see home for one last time and we can initiate this with a carer and transport for an hour at home. It is tricky to organise, but it is worth it when you see the joy on that patient’s face when they return after seeing home for the last time. Unfortunately, this was not an achievable goal with lockdown. However, I am not one to give up so after speaking to the patient’s husband we set up for him to video the house room by room and include the cats on it too. He did this and returned with it on his phone. After a bit of IT help we downloaded 2 short videos onto a laptop that we left in the patient’s room. She watched the clips with animation showing staff her beautiful home that she was so proud of. The cats (too feral to visit apparently –  we had suggested) also made an appearance and the patient was ecstatic to see them. She watched those clips daily for a couple of weeks before she became too unwell to watch. A positive and happy outcome. If you can’t go home, we will bring home to you.

Another day was when a patient was dying and was Covid +. One family member was allowed to see her and say goodbye with full PPE on but others were upset they could not say goodbye. I set up a WhatsApp call and family came on to say their goodbyes to her. Although the patient was unresponsive, hearing is the last sense to go so we truly believe she died knowing that all her loved ones said goodbye before she died. We had volunteers knitting hearts for the Hospice and the patient kept one and the family were sent matching ones that were bagged for the quarantined period prior to sending out.

As a social worker I have utilised facetime and whatsapp to connect family and friends. We have had family/MDT meetings in the gardens sat 2 metres apart and we have given lots of virtual hugs and hands on shoulders to comfort. It has been difficult at times trying to make a difference at end of life, but I feel we have been successful within our restrictions and limits.

I have had my heart-breaking moments when you cannot initiate change. A lady in her 50’s was troubled constantly in her last week of life. When I asked her what it was and could I help she replied that she was struggling to decide which 10 people could go to her funeral. How on earth can you answer that?  I could not do anything except listen. Often that helps.

A good quality of life is so important even if it is only for a day or two. I love my job and hope that we can continue to work to achieve dreams and happiness at end of life with our clients and families. I know I will keep on trying. Social Workers play such a valuable role at end of life for both clients and families and friends.