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Taking a deep breath

Ali Sewell is a hospice staff nurse at Salisbury Hospice Inpatient Unit and Clinical Nurse Specialist in End of Life Care Education in Nursing Homes. Ali explains how she copes with working in hospice care…

'This is a place which still practices the arts and hearts of palliative care; it's more than just words, it's about what you do, how you do what you do and what you do with what you know. It's an inspiring place to work.'

Ali has two jobs with the Hospice: one day a week she works as a staff nurse at the Inpatient Unit which is really close to her heart as she has been working there since 2000. Three days a week she works as a Clinical Nurse Specialist which involves visiting nursing homes to talk to and educate staff about end of life care.

'It's about talking about dying and bringing it out into the open. Advance care planning to sit down with somebody and help them say what their preferred priorities are, and acknowledge that a change has happened. Good end of life planning, such as decisions about resuscitation or symptom control... It's about choice.'

An important aspect of Ali's work is to help staff be self-aware and understand how they are feeling themselves:

'You can choose your attitude when you come into work even if you feel grumpy that day, you can choose to be grumpy or you can come to work and smile. I try to teach creative ways of managing emotions, for example I put my feelings about someone from my personal life outside in the first aid box by the door, telling them "don't worry I haven't forgotten about you but I'm not going to think about you while I'm at work and I'll pick you up on the way out of work".

'Then when I come out of work, I leave my feelings about work in the airing cupboard because I can't do anything about that patient who has really upset me because she reminds me of me, or the young woman who has five children and isn't going to see the week out. I'm going to leave those feelings in the airing cupboard.

'Then if I feel sad about anything I'll give myself time to cry and feel this, then I'll say "no and if you pop into my head I'm going to say get back into that cupboard". So it is about thinking creatively about how to deal with very difficult emotions.'

Ali is very passionate about mindfulness as well. She explains: 'It's about what is happening here and now. If I have a stressed colleague, I'll say to her "come on now, just lower your shoulders, close your eyes and just breathe in and then out; focus on your breath and as you breath out, nobody is looking at you, smile".

'This helps with understanding that when you are getting anxious you stop breathing, then go into fight or flight or freeze mode, so the oxygen is all going down your body, your head starts aching, but two minutes out in the loo or somewhere to just ground yourself with your feet on the floor (holding your thumbs is quite useful to make a connection), then just breathe to get the oxygen back up to your head so you stop panicking.

'With all of the pain people feel about dying, as a nurse you have to accept this is not your death, this is not your loved one and if you lose sight of that fact you are doing no favours for the people you are looking after because you will disable yourself so you won't be able to help them. You still feel compassion but you don't allow yourself to fall into the pit with them. If you stand at the edge and hold their hand and comfort them, you can do something to help.

'It's about getting people to think in a different way and with a different attitude - ask yourself: if you are dying, do you want someone grumpy and brisk or do you want someone who is genuinely caring and won't judge you? The hospice is a place where you can express your feelings - you can say this stinks and I hate this.

'Some people come in fighting tooth and nail and it could take our community nurses months to convince a patient to come in. That's understandable, they are frightened. They may be grumpy and defensive at first but then they relax and don't feel vulnerable. They are supported, their families are supported and they feel safe. That's what the hospice is all about.'

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