Elizabeth Tysoe is an employer liaison officer at the GMC, with a background in nursing. During the Covid-19 pandemic she worked as a volunteer staff nurse at Ashford and St Peter’s Hospitals NHS Foundation Trust in Surrey. Here, for Dying Matters Awareness Week and, in Scotland, Demystifying Death Week (both 10-16 May), she reflects on her experience of caring for patients who face death without the comfort and support of their families.
A hand to hold can make a world of difference for a dying patient. But an impact of Covid-19 has meant weighing the risk of infection and the need to say goodbye, presenting a heart-wrenching conundrum for families and clinical staff.
Dying patients should have the chance to see loved ones wherever possible. But for families who may live far apart, or have health concerns of their own, a visit may not be feasible. It is so important to ensure that families and loved ones are still involved, using whatever form of communication they and the patient are most comfortable with.
For me, and the team I worked with, video calls were invaluable in bridging the gap. Families need to be supported, especially if they are seeing a relative over the internet for the first time. It can be a shock to see your loved one looking so unwell and surrounded by medical equipment.
However, such interactions can also bring great comfort and understanding and help them appreciate why they are being asked to make some difficult decisions. Contact doesn’t have to be visual – just hearing a loved one’s voice can be enough. Staff can also take down and pass on loving messages from relatives.
The GMC’s guidance on End of life care talks about the important role of families and close friends. Where patients agree, or have previously expressed their wishes, it’s normally good to involve their loved ones and to share information. Some patients lack the capacity, but it’s reasonable to assume they would want those nearest to them to be kept informed.
Many very sick Covid-19 patients can be in hospital for weeks. Where death is a foreseeable possibility, advanced care planning needs to be offered as soon as possible, to give patients an opportunity to consider their options and speak to their loved ones. If a patient isn’t able to express their wishes, those close to them will often know what they would have wanted.
The GMC recognises that these are not easy conversations to have and we have guidance on our website which gives a framework to support doctors in meeting the needs of a patient as they reach the end of their life. There are also learning materials, including videos and case studies that cover such topics as sharing information with family members, and talking about end of life care.
The pandemic has taken many lives in tragic circumstances. Let us hope that it has also taught us the importance of keeping people connected, and some innovative ways of doing so in difficult circumstances. It important that we do all we can to help people find comfort at such a distressing time in their lives.