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Timeline of the night


Find out how a night might unfold...

 

Every night is different for each of our patients, but our timeline will give an idea of what a night might look like for our Hospice at Home team and the patients and families we care for... 

8.00am -11.00am 

Arthur Rank Hospice Charity Hospice at home appeal The Hospice at Home day starts with looking at what has happened the night before. The Clinical Nurse Specialist comes into the office and receives the feedback from the Healthcare Assistants who have been in patients’ homes overnight. 

If a patient has required any additional medication or has been unsettled overnight, the Clinical Nurse Specialist will call the GP or the District Nurses to advise about any changes in the symptom management plan. 

The Clinical Nurse Specialist will go through all the patients on the caseload, looking at the computer system to see if they’ve needed any additional medication or input overnight. Having gone through all the patients to get a thorough overview, they then make the decision on who will definitely be receiving Hospice at Home care that night. 

The decision about which home the Healthcare Assistant is allocated to, also involves considering where the staff member and the patient live and how well their personality will suit the family and patient’s needs.
Not all decisions on care being allocated are made at this point. There may be other urgent referrals that come through later and having a couple of extra Healthcare Assistants available allows the service to be very responsive at a time of crisis and need. 

If somebody has had a particularly difficult night, the Clinical Nurse Specialist will also provide additional support for the family over the phone. 

11.00am -4.00pm 

During this time new referrals may be received by the Hospice at Home administrator or Central Referrals at the Hospice, from District Nurses, GPs or the Arthur Rank Community Team. Each new patient or family is then contacted by one of the Clinical Nurse Specialists and assessed over the phone, to evaluate if care is required for that night. 

The assessment will look to establish what the patient’s current condition is, what their needs are and what their symptoms are. The team also try and establish how well the family is coping from an emotional perspective, what the family’s understanding of the patient’s current condition is, and whether they recognise that the patient is approaching the end of their life.

The Clinical Nurse Specialist may also provide further support to the family, to help them understand or manage what is happening at this point. If anything more unusual or complex becomes apparent, further advice or help may be sought from the service’s Matron  or one of the Hospice’s palliative care consultants. 

Arthur Rank Hospice Charity Hospice at home appeal Calls will also be made to whoever made a referral for the patient. This is in order to complete a risk assessment regarding the patient’s home, taking into account that our staff work on their own and their safety is paramount.  

In some instances the Clinical Nurse Specialist might arrange to visit the home. This allows them to assess the support needed in more detail, to help with unmanaged symptoms and to communicate between healthcare professionals who may be involved with the patients care. 

4.00pm – 6.00pm 

When the difficult decision has been made as to who will be receiving Hospice at Home care that night, calls will be made to those families by a Clinical Nurse Specialist or a Healthcare Assistant to let them know that care is available and who will be coming. At this point, the Healthcare Assistant is booked and given all of the information about the patient they are looking after that night. 

Unfortunately, due to the demand on the service and time constraints on the team, it is not always possible to call families to inform them that they will not be receiving care that night.  However, some families definitely have to know that they haven’t got care available, because they need to practically plan and psychologically prepare for the night ahead.  In these instances, a call will be made to advise that care is not available that night. However, the team will reassure family members with advice on what to do and who to call if the patient’s condition deteriorates.

6.00pm - 9.00pm

The Healthcare Assistants wake up from their previous night shift and receive the handover information about the patient they will be caring for that night. 

They make an introductory phone call so the family can put a voice to the name and knows who to expect.  

They may receive an update on the patient at this point and be able to offer support or advice. If the patient is particularly unsettled or the family have any concerns, they can advise who to call or what to do. 

9.00pm -10.00pm

The Healthcare Assistant travels to the patient’s home. The service covers all of Cambridgeshire, Huntingdon and Fenlands, so depending on where their own home is, a journey could take anything from 5 minutes, to an hour and a half. 

10.00pm - 7.00am 

Arthur Rank Hospice Charity Hospice at home appeal The Healthcare Assistant arrives at the patient’s home and gathers further information from family members on how the patient is doing. The family member or carer shows them around their house and introduces them to the patient.  

Arthur Rank Hospice Hospice at home Some family members are so exhausted and relieved to have this support during the night that they go straight to bed. Other family members just appreciate having somebody to talk to and might share their concerns over a cup of tea. This also gives them an opportunity to develop trust and confidence in the Healthcare Assistant, enabling them to relax and sleep better that night. 

Having gained a more complete picture of the patient’s situation, the Healthcare Assistant spends time with them. They may re-position them, check their skin for pressure areas, take care of their personal hygiene needs and mouth care, moisturise their skin or offer a massage if appropriate. 

The Healthcare Assistant remains awake as the household sleeps, checking the patient periodically. If the patient has become unsettled, they will check for anything that could be causing this. According to what the family requests, if the patient cannot be soothed, the  Healthcare Assistant will either wake the family up or call the On-call Nurse or District Nurse to come and assess the patient and administer any medication needed to alleviate the symptoms.

Having gleaned further information from their assessment, the Healthcare Assistant may feel that accessing support from the wider Arthur Rank Hospice team, may be of benefit. This may involve, for example, a request for spiritual support or complementary therapy. This will be passed onto the Clinical Nurse Specialist in the office, who will process it to the appropriate team. 

Arthur Rank Hospice at home Throughout the night the Healthcare Assistant will continue to monitor the patient. Prior to the Healthcare Assistant leaving a patient’s home, they will update the family on what has been happening overnight, answer any questions that they may have and offer further support. There are also times when they have to have difficult conversations, as a patient could have deteriorated over night.  They may even need to break the news that they feel things are changing and the patient may even be dying at that point or sooner than expected. 

Arthur Rank Hospice Charity Hospice at home appeal Often, when caring for a patient in the final hours of life, the Healthcare Assistant is able to recognise subtle changes in breathing and skin colour that may indicate that the patient’s family need to be woken if they would like to be there at the death of their loved one.  After a patient has died, the Healthcare Assistant can provide vital comfort, psychological support and practical advice on what to do next. They will do things like wash the patient, call the District Nurses and out of hours Doctors and maybe even the Funeral Directors.  

In this way the Healthcare Assistant can support the family and relieve them from the practical elements of what needs to happen at this point. This allows loved ones the time to process what has just happened, as they will sometimes be in shock or may need time to sit with their relative.  It doesn’t matter how well prepared a family might be for their loved one’s death, no-one really knows how they are going to feel until it actually happens. 

7.00am 

The Healthcare Assistants complete an electronic handover form which will be sent to the Hospice at Home office for the Clinical Nurse Specialist to assess and the process starts again. 

 
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