Being kind ……. it’s as simple as a smile or a squeeze of a hand

Last week we launched our new strategy and values, and over the next few weeks I’ll be bringing you stories from everyday people, who live our values in their day-to-day jobs.

One such person is Anna Tilsley, who works as an Associate Charge Nurse in the Critical Care Complex. Anna embodies the value of being kind and has been doing some amazing work around end of life care. Anna shares her story.

Anna Tilsley
Anna Tilsley

I guess my interest, in end of life care, started 12 years ago when my grandad passed away. Grandad spent the last few days of his life in an acute surgical ward where the focus was on cure. For that reason, nurses were uncertain about providing adequate pain relief and comfort due to the fear of hastening death.   Instead of having a peaceful, and comfortable death that he hoped for, grandad ended his life, distressed and in pain.   It’s an experience I will never forget, and I vowed that although I couldn’t improve his experience I could change it for other people.

As a nurse, I’ve been privileged to spend time with patients who are dying. The best thing you can hope for is that people spend their final hours, comfortable, pain-free and in the company of people who they love.   That’s why for the past three years I have been implementing ‘Manawanui’ which is a care of the dying pathway used in Critical Care. This pathway encompasses the spiritual and cultural needs of not only our patients and families but our staff. Manawanui means big heart. It represents the heart of the patient you are caring for, the heart of the nurse providing the care and the appreciation that the family has towards the carers. This pathway is a tool which guides and supports the nurses to provide a ‘good death’ through symptom management and prompts for effective communication between medical and nursing staff to the patient and family, across cultural and spiritual beliefs, often different from their own.

We have such a diverse workforce at CM Health, and although we may have similar cultures, religious and spiritual beliefs, we may all want different things when it comes to our end of life experience. Awareness of your own beliefs is essential in providing end of life care to ensure individualised care. Ask yourself these questions… If you were dying, where would you like to spend your final moments?, who would you like to be there?, would you like to be comfortable i.e. pain relief?, what religious or cultural needs would you like? I asked a group of nurses these questions at a focus group the other week, and although, from similar backgrounds, everyone’s answers were different. The next question is who have you told? If you were to come into hospital, does your family know what you want?

While these conversations are important to have among ourselves, they are also important questions to ask our patients and their families. If we were asked these questions when grandad was in hospital, it would have made a huge difference to his final hours.

For me, death is just as important as someone’s birth because that’s the memory that lives on with the family or relatives. And a memory of kindness that may have huge significance to the family could be as simple as a well-timed smile, a squeeze of a hand or a cold glass of water.

The other day we had a patient who was dying, following a traumatic accident. Before her kids came in to see her, we placed a beautiful patchwork blanket over the top of her to cover her bandages. The whole atmosphere in the room changed, and it meant the world to the patient and her family. While we tend to do things like this every day and not think too much about it, we forget that this means so much more for the people we care for

As for my goal – I’d love to set up a service that caters for acute people who are dying in hospital – giving them a choice to go home to die. At the moment, there isn’t a lot of support for families looking after their loved ones at home in their final days.   I want to provide that support, whether it’s giving advice over the phone or administering pain relief if people are unsure or afraid to give it.

Currently, I am working with the end of life strategy group to develop an end of life pathway for Ward use and a tool to identify the correct treatment path for the patient.   For further information, you can contact me via email:

Our staff show acts of kindness every day and while we tend to do this automatically, we forget what this means for the people we care for.  If you have stories to share about how you demonstrate our  core values:  Kind (care for other people’s wellbeing), Valuing everyone (make everyone feel welcome and valued), Together (include everyone as part of the team) and Excellent (safe, professional, always improving), please get in touch via my blog or email:

Anna and Geraint

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Author: Geraint Martin

Geraint Martin was appointed Chief Executive Officer of Counties Manukau DHB in December 2006. It is one of the largest District Health Boards in New Zealand and services a population of half a million. He has significant experience over 30 years in national policy & in managing both primary and secondary care . Previously, he was Director of Health and Social Care Strategy at the Welsh Government .He authored a radical 10 year strategy of reform, including the successful “Saving 1000 lives” Campaign.Until 2004, he was CEO at Kettering General Hospital & had held senior positions in London & Birmingham.He has worked closely with clinicians in improving clinical standards,patient safety,chronic disease management & managing acute care to reduce hospital demand.In NZ, He has promoted clinical quality and leadership as central to improving patientcare. This has led to a significant increases in productivity and access, whilst maintaining financial balance. CMH has completed in 2014 a $500 m capital redevelopment programme, the largest in New Zealand. A central part of this is the establishment of Ko Awatea,the Centre for Innovation and Research which will underpin CMH as one of the the leading health systems in Australasia.In 2008, he chaired the Ministerial Review of Emergency Care in New Zealand, and in 2013 was an member of the Expert Advisory Panel on Health Sector Performance. Geraint has an MSc in Health Policy from Birmingham University .His post-graduate work has focused on health economics and Corporate Strategy . He is adjunct Professor of Healthcare Management at AUT and Victoria University, Wellington Elected in 2006 as a Companion of the Institute of Healthcare Management, previously he was an Associate Fellow at Birmingham University.He is is Chair of the Auckland Philharmonia Orchestra, a member of the Institute of Directors, on the Board of the NZ Institute of Health Management & previously the Board of The NZ Health Quality and Safety Commission.

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