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'Hospice at home' nurse helps terminally ill patients through their photographs

A wonderful nurse, who cares for terminally ill patients who wish to die at home, explains how she gets to know them through their photographs.

When the patient is first referred to her, Catherine organises a home visit. As leader of the team that will be caring for that person until they die, when care may well be very intimate at times, she is extremely anxious that the first visit should be as relaxed as possible. That first meeting will take place in the patient's main room which may be the kitchen, living room or bedroom. There are questions that do need to be asked but in order to put the patient at their ease, Cathy takes great pains not to rush anything.

Often over a cup of tea, they will begin an informal chat where certain key questions can be asked as part of their normal conversation.

But, as well as asking questions, Catherine is also taking careful note of the photographs around the room. Proudly displayed, these are not private, so they are likely to be the patients most treasured portraits and snap-shots.

Whenever there is an awkward silence, either because the patient is upset or feeling ill or breathless, Catherine say she often looks towards one of the photos and, in a discreet way, she asks the patient or carers about them, often finding out about family members, where they live, what they do and how they have influenced the patient during their lives. This information helps her to understand the patient and often affects how she treats them as she goes about her daily care. Not only does the experience allow the patient and their carers the chance to informally recall some of the happiest moments of their lives, it also gives the nurse an picture of what her patient's life was like, what was important to them, what their interests were, the kind of friends they had, the hobbies and holidays they enjoyed. Most important of all, the experience means that the nurse, through the photographs, has seen her patient and their friends and family when they were at their best, the way they would want everyone to remember them.

Sometimes the photos will be of people who have died, either because they were very old but, occasionally, the nurse will learn that a picture is of someone close whose life was cruelly cut short. All this information helps the nurse to understand the patient and affects how she treats them as she goes about her daily care.

We have also heard of another nurse who, inspired by this idea, suggests that patients display three or four of their favourite photographs by their bedside. Often visitors and carers don't know what is best to say to a dying patient but the photographs provide an immediate source of conversation. They may be of the patient's wedding, with their grandchildren or winning an award. Whatever they are, they will trigger a memory or prompt a thought from a visitor that will bring a smile to the patient. To vary the conversation, the pictures can be changed as appropriate.

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