Mother nature

Specialist sister Kate Tantam has helped create an outside space for patient rehabilitation which is playing a unique role in COVID-19 recovery

To be outside.

To drink a can of beer.

To feel the rain.

These are some of the requests from critical care patients when asked what they think could help aid their rehabilitation.

And thanks to the innovative work of specialist rehabilitation sister Kate Tantum and her team at Derriford Hospital in Plymouth, Devon, these wishes are being granted.

Some patients at the hospital, even if ventilated, can be wheeled out to a dedicated outside space – a “secret garden”, where they get to benefit from fresh air and all that nature has to offer – sunshine, wind, drizzle. And sometimes, with the odd Doom Bar alongside.

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“Taking people outside seems like a small intervention but it’s massive for their mood and quality of life,” says Kate, whose innovative work on the garden and its positive impact on patient rehabilitation during the pandemic has recently been recognised with a British Empire Medal. 

There's a power in nature

“We are very passionate about supporting patients with their recovery,” says Kate. “My job as a senior rehabilitation sister is to look after them in intensive care, follow them up after and manage that transition with them.

“At Derriford we work with the patients and give them a holistic goal for what they want to achieve in rehab and then, where possible, we take that goal outside into the garden. 

“Obviously due to the pandemic we’ve had to adjust – and where once grandchildren could come and visit, we can now do video calls from the garden instead,” adds Kate, who explains that the garden has been open since 2018 and has had to evolve with the times.

Kate, who prior to the pandemic was known for pioneering the use of pet therapy dogs in ICU, says Derriford is not the first hospital to have a garden but it is the first centre to take COVID-19 ICU patients outside.  

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Staff and patients in the garden at Derriford

“One of the things that is really important is the humanisation of intensive care, because it is a very hard place to be,” says Kate. 

“There’s a power in nature – it’s really grounding,” she adds. “There is nothing like feeling cool when you’ve been in hospital. It makes you feel normal. By taking people outside, you are giving people back themselves.

“We’ve had birthdays, even wedding parties in the garden, and of course for Christmas we decorated the trees. If it looks nice it makes a difference to how people feel.”

Empowering patients

Kate says that it’s often underestimated how depressing hospitals are for people – especially in ICU. “We treat people, but we don’t always give them the skills to get better. By taking people outside you’re showing them what their future can be like – you’re empowering them – and this is vital for their recovery.”

It’s for this reason Kate is petitioning for every hospital to have a dedicated outside space such as the one at Derriford. “It is difficult to set up and obviously you have to risk assess, which can be stressful, but it makes the world of difference,” she says. 

“We knew it was going to be challenging to take COVID-19 positive patients into the garden. But we have proved it can be done safely. It is possible.”

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Birthdays and even weddings have taken place in the garden

Kate says that as well as using the garden for rehabilitation therapies, they also take patients outside who are delirious.

“It helps turn on their day and night setting and tune into their circadian rhythms so they are less likely to be delirious. Delirium is an under-resourced problem and if we can tackle it, then our patients get better quicker.”

You are giving people back themselves

“One of the biggest issues the NHS has is that it sees rehab as the icing on top of the cake but not the icing in the middle of the cake sticking it together, so I am trying to alter that perception,” says Kate, who is dedicated to raising awareness of the realities of rehabilitation and the advantages nature can bring.

And it’s not just patients that benefit, explains Kate. “The use of outside space makes a difference to staff wellbeing too, which helps resilience. Us nurses like to see patients happy and vice versa – it makes everyone feel better.” 

‘A magical thing’

While a patient at Derriford, the explorer Robin Hanbury-Tenison was taken into the garden where he awoke for the first time after almost dying of COVID-19.

He says: “They wheeled me out in a great big bed, with tubes going out in all directions, just to a flowerbed with a shaft of sunlight coming down into the courtyard.

"There was a glorious moment when I woke up and was aware that I was back. I was surrounded by nurses looking like space invaders but chatting away. It was lovely.

 "We shouldn’t forget the healing power of nature. I think hospitals should have secret gardens. It’s a magical thing."

Rehab legends

Kate launched the #rehablegends social media campaign in 2018 where her team shares patient, loved ones and staff stories to promote the “little things” that happen every day, promoting rehabilitation and recovery.

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