Clinical Nurse Specialist - FAQs

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Who has referred me to the Pilgrims Hospices clinical nurse specialist?
Usually the referral comes from your own GP, district nurse, hospital consultant /doctor or hospital Macmillan nurse.

Each referral is seen by the hospice consultant or senior nurse.

Where do my GP and district nurse fit into this?
Your GP is always informed prior to our involvement. Your GP and district nurse remain responsible for your day to day care. The team does not take over your care from your family GP or District Nurse but works alongside them to help with any problems if they occur. Following all visits your GP and district nurse are contacted regarding any recommended changes in medication or treatment management.

What happens when I am first contacted?
The Pilgrims Hospices clinical nurse specialist arranges an assessment appointment. The appointment is to meet you to find out whether the team can be of benefit to you in your care. During the appointment you will be asked about yourself and your family, your illness now and in the past, your present problems and any medication you are taking.

The clinical nurse specialist will make telephone contact with you and/or your family within 7 working days of the initial receipt of referral.

An appointment is confirmed to meet you; this may take place at your home, the hospice or a community clinic.

Assessment
All patients referred to the service will be offered an initial assessment. This will explore physical, psychological, spiritual and social issues where appropriate, with the aim of helping to identify the impact of your illness on you and your family and where best we can help you

How often will the nurse contact me?
Following the assessment a plan will be made with you which intends to set clear goals for your care. This will help plan the frequency of any appointments you may need. Generally one of the following will be offered:

• A single consultative visit, normally in your own home.
• Short-term intervention when problems may need several visits to help resolve, some of which may take place at the hospice as an outpatient.

The plan is flexible to suit your needs and for those patients who may require more than one visit we will regularly review your care plan with you

You may be discharged if your condition stabilises or if intervention from the team is no longer necessary. You can come back to us at any stage to request reassessment.

Will I have to be admitted to the hospice?
No, the nurses aim to support you in your own home/nursing home if that is what you wish. Admission may on occassions be recommended if your symptoms become too difficult to control at home however if this is not what you wish then of course we acknowledge and respect this. While an in-patient the hospice doctor is responsible for your medical care. On discharge your GP will be sent a report of your stay and any changes made to your medication.

If admitted, how long would I have to stay in the hospice?
Hospice stays are generally for about two weeks, but many stays are shorter. However, once your symptoms have been controlled and you are able to return home, we plan your discharge home and discussions will be held with your family, carer, district nurse and Social Services if additional help and support is required.

What happens if I need urgent hospice admission?
We aim to prevent any emergencies developing. If admission is recommended we will arrange this for you as soon as possible.

What happens if I still need the hospice but my symptoms are stable?
You may be referred to other members of the hospices Multi-Professional Team for advice and support.

The day hospice provides a range of services in the hospice building where you can also meet other patients.