26 | Nursing in Practice | Summer 2022
MY DAY
Working as a Diana nurse supporting sick children
Carmela Scott , lead nurse for the Diana team at East London NHS Trust , shares a day in the life of her team as they support children with life-limiting and life-threatening conditions in the community
PAUL STUART
08.30
The day ’ s first communication comes from our on-call manager , who has been contacted by a family overnight via out-of-hours support . The on-call manager can help with symptom management or changes to care plans . The Diana team ensures all communication has been forwarded and identifies if an urgent response is needed . Children ’ s palliative care is about the best possible quality of life and care for every child with a life-limiting or life-threatening condition . Giving families real choice is key to this approach , helping to prevent unnecessary admissions and enabling treatment to start at home . We work with the local hospice and specialist palliative care teams to offer this support , which allows for parallel planning of care within the community .
09.30
Time for our team meeting , with continuing care nurse specialists , a play specialist and the psychology team . We discuss the caseload , identify any concerns with individual patients and discuss patients ’ current support needs , and what other services could be introduced .
11.00
Today , we receive a referral for a baby in hospital who has suffered a deterioration in his life-limiting condition . His parents have consented to referral and are aware of the diagnosis and prognosis .
First , a member of the team contacts the referrer to discuss the child in more detail . We will then contact the parents by telephone to introduce the service , with due regard to the emotions and sensitivity involved .
The team will visit the baby and family before discharge , to help with transition from hospital to home . We also meet with others involved in the child ’ s care and join up with the psychology team to discuss support within the community .
Families often don ’ t realise the amount of support they can receive at home and so may be anxious about leaving the safety of the ward . A meeting on the ward allows families to ask questions and make informed choices , and gives the team a chance to understand the family situation and their concerns before discharge .
12.30
The needs of our children can change regularly and prioritising unwell children can change a day ’ s outlook and require reallocation of care . We communicate via ‘ Pando ’, a messaging service for healthcare professionals , as well as by phone and email . There are safety precautions to cover lone working in the community .
Today , two team members visit a child who has been discharged home for end-of-life care . We put plans in place for symptom management and reviews , and supply medications for expected and unexpected symptoms . A palliative care doctor is asked to join the home visit virtually , enabling joint review and allowing the parents to have concerns addressed .
13.30
Today we are able to have lunch together , which is great ! As a team , it is important to have that togetherness , and touch base on each other ’ s wellbeing . After lunch , we complete documentation and follow up our home visit , which must be done as soon as possible . This could involve the GP with regard to medications , checking supplies such as syringes in the home and discussing planning with other professionals .
14.30
There is a CIN ( child in need ) meeting arranged by social care . Each child has an allocated nurse who attends these meetings to provide updates and share concerns . We discuss patients regularly , so another team member can step in if the allocated nurse cannot attend . We work closely with social care and most children with complex needs have a CIN plan , which is regularly reviewed , with any support needs or safeguarding concerns flagged up .
15.30
Another home visit for a child who is stable , but whose condition could change at any time . A team member reviews all aspects of the child ’ s wellbeing and care . Information is shared with professionals such as a dietitian and others involved in care , to make sure medications are optimised and the feeding regimen is maintaining the child ’ s weight . When we return to the office , we will update the system as needed .
17:00
Home time . Sometimes we phone another team member before going home to reflect on the day so we don ’ t take our challenges home . Our team is made up of parents , partners and people with families , so it ’ s important to wind down and enjoy our personal times so we can give our best the next day .
We are very proud of the service we provide in our community . It is extremely rewarding as it allows us to support children and families in their own home , providing health advice , reassurance , emotional support and forward planning as they navigate a very challenging journey .
The Diana team at East London NHS Trust ( l to r ): Carmela Scott , Katie Lewis , Nasayha Tahrim , Lizzie Sibanda