Night nurse humbled by work

A Kilmihil-based cancer support night nurse says she is “humbled” by the welcome she receives from families while she is caring for their loved ones.

Working with the Irish Cancer Society (ICS) since June 2002 as a night nurse, Anne Normoyle is one of the night nurses who are the link between the living and the dying.

Speaking at the launch of the ICS’s Relay for Life, Anne admitted there is a huge trust issue when by families let a total stranger into their home to look after a loved one at a very vulnerable stage in their lives.

“Night nurses are humbled by the fact we are accepted into peoples’ homes at such a delicate time for the patient and their family.

“A person may be all dressed up the first night but, by night two, generally, they are in their pyjamas ready to go to bed. It is a good sign that they have their trust in us to welcome us in this way.

“It is a huge honour and privilege to be welcomed into peoeple’s homes. The ICS tries to provide as much of a 24-hour service, if required, as we can,” she said.
Over the last 16 years, she says, the service has gone from strength to strength.
When she started, the society was providing on average seven nights of cover for each patient, which has now been increased to 10.

The number of night nurses has also increased to between 180 and 200 nurses nationwide, providing care for patients in their own homes.

Last year, the number of requests for night nurses was down slightly but the society still provided 7, 345 nights for 1,800 patients, down from more than 8,000 the previous year.

While about 95% of requests for night nurse cover are met, she acknowledged that there are times when night nurses are not available or are already booked up.
In 2016, she recalled, 88 nights were covered for 29 patients in Clare.

The job of a night nurse is to take care of terminally-ill patients of all ages, from newborns to 100 years of age, and a few respite care nights, if a patient is unwell after radiotherapy.

While the majority of patients availing of the night nurse service have cancer, she said the society also provides night-time care for patients with life-limiting illnesses, such as neurological disorders, MS, Motor Neuron Disease, Parkinson’s and Alzheimer’s, as well as adults and children with complex medical needs.

The overall approach is to provide physical, psychological, spiritual and social end-of-life care to patients and their families.

Sometimes, the needs of patients can be quite complex and require a lot of medical intervention and personal care. Night nurses must deal with issues, such as agitation, pain, vomiting and fluid retention.

This can result in a very busy night for the night nurse, in terms of their interaction with patients.

However, on other occasions, a night nurse may just need to hold a patient’s hand; talk, if talk is needed, and listen when it is time to listen.

The society works in conjunction with the Hospice to Home Palliative Home Care team, GPs, public health nurses and the Mid-West Community Intervention Team.
While, the standard hours for night nurses is 11pm to 7am, they can do a twilight shift from 5pm to 11pm or from 8pm to 8am.

Anne stressed that the nurses give as much respite and support to patients as they can.

“It is a huge undertaking for any family to look after their loved one at home. It can sometimes feel a bit overwhelming for a family so it is vital that the society gives them as much support as it can,” she said.

Bookings are normally taken through Milford House and Hospice in Limerick or the night nurse office in Dublin.

And if medications for a patient don’t work at night, she explained, the night nurse would normally ring Milford Hospice before Shannondoc, the GP out-of-hours, as Milford staff are specially trained in palliative care.

The following morning, the night nurse would liaise with the home care team, if further changes are required for a patient’s medication.
“Sometimes, by the time a night nurse is called in, a patient may be unresponsive, which is rather sad, as we don’t get a chance to speak to the patient. However, we get a sense of what the person was like, from stories shared by their family members,” Anne said.

“There are tears, laughter, anger and grief, love and compassion, all at various times. Night nurses hope that, by being present and allowing families to tell their stories, it will allow them to vent their frustration, anger or despair and help them in some way.

“Sometimes, 3am or 4am in the morning can be a hard, lonely time for patients. We find that they do open up to us at that time. We feel a bit sorry for the Home Care team, who may have been visiting the family for months or years, and the family may open up to us because we are with them at their most vulnerable time.

“We are holding the hand of the dying but we are also holding the hand of the living, while they grieve and prepare to let go of their loved ones.

“From the bottom of my heart, it is an honour and privilege to be a night nurse. I am so lucky I got this job 16 years ago and I hope I have many more years in the service.

“It is wonderful to be part of people’s journey at such a hugely difficult and sensitive time. Everyone reacts differently to grief. There is no right or wrong way,” Anne concluded.

by Dan Danaher