‘The children’s hospice is a very positive and motivating environment where there are lots of opportunities to practise most nursing skills but especially the fundamentals of care which there are far fewer opportunities on wards. It is a good placement to develop skills learned previously and applying theory as there is more time to do so.’

Anonymous student feedback on hospice placement

We hope that you find the following information will be useful when you are preparing for a placement at a children’s hospice:

• Support: It is widely recognised that working in a children’s hospice can be stressful. Prior to your placement please consider your own personal circumstances, for example having your own children or a recent loss/bereavement. You may wish to discuss these issues with your mentor or one of the senior members of the team, in confidence, so that we can make sure you feel appropriately supported. We endeavour to create a mutually supportive and friendly atmosphere. You will have the support of all members of the care team, as well as a mentor/practise supervisor according to your course requirements. We’ll try to make sure you have fun.
• Staffing: Many children’s hospices endeavour to care for children on a 1:1 basis. There is always a qualified children’s nurse on duty as well as other members of the multi-professional team. This team consists of nurses, nursery nurses, experienced care assistants, occupational therapists, physiotherapists, play and music therapists and counsellors. There may be a paediatric consultant and other doctors including general practitioners who work with the hospice team.
• Uniform: Children’s hospices are independently run and you will need to ask what uniform you should wear on placement. Also ask about the uniforms of different staff members within the multi-professional team at the hospice. It will be important to wear your name badge and student ID at all times. Many children’s hospices have hydrotherapy pools – if there is one at your placement hospice don’t forget your swimming costume if you are willing to join in swimming sessions!
• Staff changing and where to leave your things: Some children’s hospices can provide a small locker for your use and/or there may be a staff changing room that is locked to all families and children. Ask where you can leave your things when you are on shift.
• Shifts: Children’s hospices have different shift patterns and you will need to ask about shift times before your placement. Children’s hospice teams working in the community to support families in their own homes work different patterns depending on the needs of the children, young people and families they are supporting. If you have a community-based placement your hours will be negotiated directly with them, as they have no set shift pattern.
• Meals: At many children’s hospices there is a home from home ethos so staff, families and children may sit together at meal times. If you have dietary requirements please tell your mentor so they can let the catering team know. In general there is a no smoking policy for staff.
• Resources: The hospice might have a small collection of books, journals and educational videos or a library. Ask if you would like to attend any teaching sessions that take place during your placement.

‘Policies and competency documents were readily available and I was encouraged to attend staff training sessions which were extremely useful. … In addition, the recourses I received ahead of starting were very welcome.’

Anonymous student feedback on hospice placement

You might find it helpful to think about the following potential learning opportunities before your placement:

• How to provide holistic care of babies, children, young people and their families living with a life-limiting condition.
• Observe and participate in the use of the hydrotherapy pool, multisensory room and music room for therapeutic activities and fun.
• Moving and handling experience with hoisting, slings, mobility aids.
• Enteral feeding.
• Management of seizures.
• Oxygen administration.
• Care of a child with a tracheostomy.
• Care of a child receiving assisted ventilation.
• Communication with children who are non-verbal/have sensory or cognitive impairment.
• To observe and discuss the use of the ‘cold bedrooms’ for care of the child after death.
• Participation of play/activities with children, young people and siblings.
• Observation of drug administration/calculations.
• Working with the multi-professional team including doctors, OTs, physiotherapists and understanding the roles of the music therapist/complementary therapist and counsellors.
• Experience with the children’s hospice community-based team if there is one.
• To discuss the provision of day visits or day care if this is part of the service provision.
• Understanding of bereavement support and the role of the emotional therapy team.

Parent perspective

‘The nurses who added most value to our family’s lives were those who asked us how we were, who were aware of each of our needs and knew our family’s values, priorities and strengths, who listened to the answers we gave and those who demonstrated respect, empathy, kindness and understanding and who were never judgmental.  It was also important for me, my husband and other daughter Annabelle to be complemented on our strengths and the difficulty of our situation to be acknowledged.  Being positive, hopeful and good company were also very important.

It was important to us to spend as little time as possible in the business of healthcare and as much as possible living our lives as we wanted to; this varied as Sally’s needs changed and initially was about her spending time at school and with her friends and later was about us supporting her to engage with the people around her and for her symptoms to be controlled as a means to her living as full as life as possible right to the end.  She liked to have procedures whilst she was watching television or doing craft and hated being crowded.  

I needed to be able to discuss distressing symptoms such as Sally’s difficulties with swallowing, not being able to close her eyes, pain, vomiting and being hungry. It was helpful to have support to develop a framework for the routine of when and what to eat and drink and the timing, dose and type of medications, so that we could concentrate on being parents. 

It was also important for us that we could seek advice from people who were experts in their field and for nurses involved in our family to either be able to provide advice or be aware of her own limitations and to be able to let us know about other people who could help us. This included advice about equipment, funding, education, counselling and access to wish and other charities. 

We noted that it was when health practitioners paid attention to detail, e.g. during admission to hospital, labelling samples correctly and chasing for results, that as little time as possible was spent waiting around and so that we could be in and out of hospital as quickly as possible.

It was important that we were empowered to be able to leave the hospital to walk and play outside even when hooked up to drips and drains.

The petty rules of hospital were infuriating, like having notes on the playroom door saying it will be closed if not kept tidy; it is almost impossible to tidy to the same standards as you would do normally when you are cradling a vomiting toddler. 

The nurse had a role in empowering Sally’s teachers and other school workers to feel confident about managing her health and any emergency situations and in helping us educate other parents. Sally did not like walking with her frame, she preferred to hold an adult’s hand and she hated using a special toilet with a frame around it and a pen with a special grip – she did not want to feel different, unless this involved privileges! I think that the nurse has a role in helping children and families to balance risks and benefits, to act as a negotiator and advocate to ensure that the child feels as free to live their life as close to what they perceive is normal as is possible.

Privacy and being respected was important to us, were possible I was choosy about who cared for us and when possible I liked to be able to do things myself for example removing sticky dressings, this sometimes took a while!

It was really important for anyone visiting to spend time acknowledging Annabelle and spending time with her, she benefited from in home play therapy this was her time to feel looked after.’

(Written by Sally’s Mother)