HammondCare is an independent Christian charity specialising in palliative care, dementia care, rehabilitation and older age mental health. HammondCare provides these services in NSW through sub-acute hospitals (Greenwich, Neringah and Braeside), residential care and innovative community care services.

Set in the peaceful suburb of Greenwich, the Palliative and Supportive Care Service within Greenwich Hospital provides a 25-bed inpatient unit, a day hospital, outpatient clinics, lymphedema in and outpatient service, community outreach, bereavement counselling and telephone advice 24/7.The service comprises a committed team of health professionals (Medical, Nursing, Social Work, Physio, Occupational, Recreational, Massage and Art therapist(s), Pastoral Care and Bereavement Counsellors) dedicated to providing high quality end of life care, symptom control and rehabilitation to patients and their families affected by a life limiting illness. We care for approximately 500 inpatients a year, and have up to 200 patients on our community list at any given time. We are committed to giving people the choice of dying at home and where possible to provide the support to make this possible.

How would you benefit from a PEPA placement?

This will depend on what your learning needs are. During your placement you will receive education and support from experienced palliative care health professionals. This includes:
• orientation – to the service and a package of useful resources and information
• mentoring by our Clinical Nurse Educator (CNE) and Consultant (CNC) and Nursing Unit Manager (NUM) to ensure that your learning objectives are met
• opportunity to attend:

  • multidisciplinary case conference meeting(s) inpatient and/or community
  • Doctor’s and CNC round(s)
  • family conference(s)
  • family support groups
  • staff debriefing
  • a community home and/or an outreach visit to a hospital within the Northern Sydney Health District

• opportunity to:

  • attend inservice(s)
  • develop or refresh your clinical and physical assessment skills through face to face teaching and utilising our available e-learning resources and library

As part of its commitment to teaching and learning HammondCare has established two Clinical Training Centres located at Hammondville and Greenwich.  The Clinical Training Centre at Greenwich is focussed on Palliative Care and Pain Management and is currently involved in a wide range of research projects in Palliative Care that may be of interest, for example we currently have an innovative nursing research project in progress in conjunction with the University of Technology Sydney and the Pam McLean Communication centre with the aim to improve nursing communication skills through the use of role playing with actors and real life scenarios. Additionally, the Clinical Training Centre hosts a variety of seminars and workshops related to Palliative Care throughout the year.

cpc-team-intake-meeting1The Barwon Health Palliative Care Program based in Geelong, Victoria has enjoyed hosting 30 PEPA placements over the years, and we believe we offer unique and innovative perspectives on end of life care for the participants who spend time with us.

The Barwon Health Palliative Care Program is a specialist interdisciplinary palliative care service, which is committed to providing an equitable, seamless, person-centred approach to our community; strengthened by education, research and development.

A distinguishing feature of our palliative care program is that we provide a range of integrated services across the acute, sub-acute and community based settings. With all services based within one program and under the direction of an Executive Director, Clinical Director, and Manager, we are resourced to provide a wide range of experience to PEPA participants.Our Palliative Care Program encompasses;

  • Community Palliative Care (located at the De Forest House, McKellar Centre, Ballarat Road, North Geelong); a team which includes 2 clinical nurse consultants, 1 nurse practitioner candidate, medical consultant, registrar and specialist community palliative care nurses, working under the leadership of a coordinator
  • 15 bed Palliative Care Unit and 1 ‘swing’ bed – shared between Palliative Care and GEM (located at North Wing, McKellar Centre, Ballarat Road, North Geelong) and including a medical consultant, registrar and junior medical staff, 1 nurse unit manager, 6 ANUMS, 1 clinical nurse specialist, and supporting nursing and allied health staff
  • Hospital Based Palliative Care Acute Consultancy Service (located at the Geelong Hospital, Ryrie Street, Geelong) consisting of a medical consultant, registrar, junior medical staff, clinical nurse consultant (CNC) – non-malignant, and an oncology/palliative care nurse practitioner candidate.
  • Outpatient clinics
  • Cachexia Clinic
  • General Palliative Care Clinics at the McKellar Centre and Andrew Love Cancer Centre, Geelong Hospital
  • Dyspnoea Clinic (due to begin sessions July 2013)
  • Nurse Practitioner Clinic at the Andrew Love Cancer Centre, The Geelong Hospital (to commence April 2013)
  • Psychology Clinic
  • Social Work Clinic
  • Clinical trials team currently overseeing seven research trials
  • Supportive care team comprising of a clinical psychologist, grief and bereavement counsellor, social worker and supportive care worker – spiritual
  • Project & Administration team comprising a range of administration staff, an education coordinator, and project workers involved in innovative projects such as Telehealth
  • Volunteers, a program coordinated by the Volunteer Coordinator
  • Sub-regional & regional team which provides medical, nursing and allied health consultancy service to our sub-regional palliative care partners on the Bellarine Peninsula and Colac
  • Shared care arrangement with Community Nursing and GPs which provides community based clients with optimal shared care arrangements between community nursing services, GPs,  and palliative care community specialist services

We are keen to assist PEPA participants in meeting their learning goals, and providing experiences that will enhance their current knowledge and skills and provide opportunities to further develop their passion and skill in end of life care.As a specialist palliative care service, we benefit from PEPA placements in many ways. Our staff have developed and refined their mentoring skills over time, aiming to improve their contribution to participants’ learning. Having PEPA participants present has encouraged us to review how we do our work, and make changes where there is identified need for improvement. Our service also has a productive working relationship with our regional body, the Barwon South Western Palliative Care Consortium, which includes innovative projects such as joint work on providing post-PEPA education to encourage the ongoing development of learning in the region.

We support the PEPA program because we believe immersion into a specialist service has great benefits for the participants, their services and communities, and our staff and program.
Barwon CPC Team Intake Meeting

The J. W. Whittle Unit is located in Hobart, the capital of Tasmania.
It is named after Sergeant Whittle who was a WW1 Victoria Cross recipient.
The Whittle Unit is a 10 bed palliative care unit (PCU), and provides 24 hour care to patients and their families.
 
The patients are treated with a multidisciplinary approach with palliative medical specialists, registrar and resident doctors, registered and enrolled nurses, social worker, music therapist, pastoral care worker and volunteers. Speech, physio and occupational therapists are also available as needed.
 
The PCU is a short stay unit providing symptom management, carer respite, psychosocial and spiritual support for patients and their families. Many patients return home to be cared for by their local community nurses and the community palliative care team while others choose to remain in the unit until their death.
 
The staff on the PCU take great pride in their holistic approach to care and this is complemented by hospice volunteers who provide such things as a listening ear, a friendly face and massage.
 
The PCU prides itself on being a welcoming and friendly family environment with such things as a children’s play room, three rooms where relatives and families can spend time together, a communal kitchen where relatives and friends can prepare food, and a lovely court yard which can be accessed from every room where there are potted plants, water features and a barbeque which can be used by families to share a meal with their loved ones.
 
The PCU has been an integral part of the PEPA program in Tasmania as it is the only public hospice. Participants come from all around the state to carry out their placements and have always found it to be a very positive experience. Whittle Unit staff also benefit from hosting PEPA participants. It provides an opportunity for them to meet staff in other health care settings, hear about their challenges and to develop a network of health professionals across the state.
 
Sheila Campbell
Nurse Unit Manager, Whittle Unit
&
Sally Bonde
Acting PEPA Manager, Tasmania
 
White Courtyard:
 
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Whittle Room: 
 
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Austin Health Palliative Care is located in the northeast of Melbourne.  The service provides comprehensive interdisciplinary care for patients with advanced and progressive illness and with a limited life expectancy, and their families.  Their consultancy service and palliative care unit (PCU) work closely with each other and with community palliative care providers.
 
The PCU provides pain and symptom control, carer respite, end of life care, psychosocial and spiritual support for patients and their families, and bereavement services. It has 17 funded beds and the capacity to care for 24 patients.  In 2009-10 there were 469 admissions to the unit and patients had an average length of stay of 12.17 days.
 
A key strength of the staff at the PCU is their ability to explore patient options and incorporate complementary and alternative therapies with traditional medicine.  The philosophy is to support patients to die in their place of choice.  Although the PCU can be an intense, intimate environment, staff also enjoy a good laugh.  They get great satisfaction from ensuring patient and family psychosocial and emotional health and wellbeing are the focus of care.  The PCU is proud of its holistic approach to care.  Examples of this approach include cleansing the ward through the use of sage, frankincense and a Tibetan singing bowl; and plans to research how patients respond to the use of complementary therapies in a medical environment.  Staff recognise that they need to be well within themselves if they are to provide best-practice wellness care to patients and families.
 
Recently a patient, who believed in alternative therapy and had rarely accessed traditional medicine, was admitted for symptom management.  Through demonstrating respect for her beliefs staff at the PCU built trust and when the patient returned home to finish off a few things she said “I need to go home but I’ll be back”.  Three days later she was re-admitted for end-of-life care.  Staff were proud that the patient felt confident that her needs would be met.
 
The PCU has offered PEPA placements for several years now and staff at the PCU say they “love it”.  PEPA provides an opportunity to showcase the PCU’s commitment to providing excellent care that is tailored to the patient’s unique needs and desires.  Staff report that they feel proud when participants are inspired to use the palliative approach when they return to their own workplace.  The PCU staff believe that the links created between generalist health professionals and the PCU can only benefit patient care.  The PCU is particularly keen to build stronger links with the large Aboriginal community who live in and around the area.  Aboriginal Health Workers are encouraged to complete PEPA placements at the unit and reverse-PEPA options are currently being explored.
 
Michelle Hooke
Nurse Unit Manager, Palliative Care Unit
 
Located approximately 35kms west of Sydney’s CBD, Braeside Hospital provides in-patient and outpatient rehabilitation, palliative care and aged care psychiatry services. It gives patients in the community coordinated and integrated access to treatment by a team of therapists including physiotherapy, speech therapy, occupational therapy, diversional therapy, dietetics, social work, psychology, medical and nursing services. Its principal referral hospitals are Fairfield, Bankstown and Liverpool Hospitals.
 
Braeside is part of HammondCare which is an independent Christian charity with a vision to care for people facing the hardest times that life can provide-people suffering incurable illnesses, and also invaluable support for their families, people suffering with dementia, and those unable to care for themselves.
 
In the Palliative Care Unit a majority of patients will have an advanced cancer diagnosis with a small proportion with end stage renal, heart and lung disease.
 
Approximately 60% of patients will be referred from both community and the major referral hospitals for symptom control, i.e. escalating pain, nausea & vomiting, constipation. The remainder will be admitted for end of life care.
 
The big challenges on a day to day basis are access to beds; with an increasing number of patients requiring single rooms because of multi-resistant organism infection. With our diverse multicultural population it can sometimes be difficult to access appropriate interpreters, particularly in our Day Hospital.
 
Our main strengths are being able to consistently provide a safe and secure environment for patients and their families; to be able to give time to patients and families to work through their hopes and fears with a multi-disciplinary team; the reassurance of regular and consistent review with good symptom management; being able to respond to calls of distress from the community in a timely manner and the benefit of a large research team has added a new dimension to our work at Braeside Palliative Care.
 
Depending on their learning objectives PEPA NSW participants can experience the palliative approach in a number of settings such as the purpose built palliative care inpatient unit, multidisciplinary team meetings to plan patient care, Outpatient clinics, Day Hospital and community visits.  Participants can experience palliative care provision in a culturally diverse setting with a multi-disciplinary team environment and an active research programme.
 
Health Professionals undertaking a placement at Braeside can expect a rich experience around caring for the dying and death in our culturally and religiously diverse population.
 
We love having PEPA participants from all Health Professional disciplines.  The exchange of ideas is always a positive for the team at Braeside. To understand some of the difficulties that another service might encounter, and often, to realise that we are very lucky to be able to work with such a diverse team in a very comfortable and supportive environment.
 
Judy Stone, Clinical Nurse Consultant, Palliative Care
Braeside Hospital, Hope Healthcare.
 
Territory Palliative Care – Top End (TPC) consists of dedicated and caring staff. We are fortunate to have both a community palliative care team as well as a modern 12 bed hospice.
Our clients and patients are very diverse in that our service includes urban, regional and remote areas; geographically we cover the whole of the top end of the Northern Territory.
Although most of our clients would have a diagnosis of a variety of cancers, we also have those with other end stage conditions, such as COPD, end stage renal disease, motor neurone disease and Micardo Joseph Disease.
We have a service that is mostly able to respond to a person’s need in a relatively short time frame and we are not restricted by waiting lists.  TPC have a multidisciplinary team that have a wide range of skills and expertise.
Some of the difficulties that the service encounters may seem insurmountable at times, but when the team have the patient’s wishes as a priority, somehow, amazing things happen.  TPC has a patient transport vehicle that we are able to, and do, take our patients home even if they live 500kms or more away.
Caring for a large amount of Indigenous patients we find that we regularly have the request for them to go ‘home to country’ to die, the staff are dedicated to making these requests a reality and when it happens everyone has a sense of completion on a job well done.
Palliative care is an approach many health care practitioners are able to implement with their patients who have a life limiting illness. However, for those patients who are a little more complicated and/or difficult to manage, our palliative care team are always available to help out.
 
Contributed by Jo Watts, Acting Clinical Nurse Manager
murdoch_community_hospice
 

St John of God Murdoch Community Hospice is situated within the tranquil grounds of St. John of God Hospital in Perth’s southern suburb of Murdoch. The 20 bed facility is unique to Western Australia as the only freestanding purpose built hospice in the state.
The hospice was opened in 1998 after 3 years of planning and an 18 month community fundraising campaign. While it started out as an independent facility, in February 2006 the Murdoch Community Hospice joined St. John of God Health Care to become St.John of God Murdoch Community Hospice. Both organizations shared their philosophy and values, and the merger left the hospice better positioned to continue providing excellent care.
The hospice is a warm and friendly place where specialist palliative care is delivered by a highly skilled interdisciplinary team. The holistic approach to care acknowledges the physical, psychological, spiritual, emotional, social and cultural needs of patients and their families. About half of the patients die during their admission, while the others will go home with improved quality of life.
The hospice also runs a day centre, Footprints, which offers a range of complementary therapies from qualified professionals who offer their services as volunteers, as well as group work, meditation, guided imagery and information, amongst other things. The aim of the centre is to support both the patient and their carers as they live with their progressive disease.
The hospice has become widely known within the health sector as an expert provider of education and training and has supported PEPA since 2003 by offering placements to nurses, GPs, allied health professionals and Aboriginal Health Workers. During this round of funding 43 PEPA participants have been mentored by the hospice staff with excellent feedback from the participants and their employers. As one GP commented after his placement:
 “Excellent placement experience. The team at SJOG Murdoch Community Hospice should be congratulated and encouraged to continue the great work they do.”
Central Adelaide Palliative Service is a metropolitan specialist palliative care service located in the centre of Adelaide, South Australia. We provide a consultative service seeing in excess of 1300 new clients a year in both hospital and community settings. We have been a PEPA host site since 2004.  During this time we have hosted a total of 46 participants including 6 Aboriginal Health Workers/ Aboriginal Liaison Officers/ Aboriginal Aged Care Workers involved in the Aboriginal PEPA Program.
 
Based at the Royal Adelaide Hospital we have been able to offer placements with our specialist service for participants to observe our inpatient liaison and community outreach roles. We have been thrilled as a service to teach the fundamental philosophies of palliative care and the palliative approach to our rural colleagues who come from a different regions of our state. These include Adelaide, Yalata, Murray Bridge, and most recently Ernabella to name a few.
 
Participants come with different knowledge and skill sets including aged care workers, aboriginal health workers and enrolled nurses, and are all eager to learn about palliative care. This program has also provided a learning experience for our service too, as we have gained greater insight into the needs of Indigenous Australians to ensure the best end-of-life care available for all in a culturally appropriate context. As a consequence of the program we have strengthened our partnerships with rural colleagues who all have similar attitudes and responsibilities in the delivery of end-of-life care. We are happy to provide ongoing mentorship to our PEPA participants.
 
We look forward to supporting the PEPA Program in the future and hope that other services take the opportunity to host our rural partners as this experience provides learning and building of partnerships for both parties. We look forward to hosting as many more health care workers as we are able in the months ahead.
 
Karen Jacquier
Clinical Service Coordinator
Central Adelaide Palliative Service
Royal Adelaide Hospital
South Australia
 

chh

Clare Holland House (CHH) is situated in a beautiful position on the foreshores of Lake Burley Griffin. Each patient room has a view to the lake or the river. Over the last 2 years the “Foreshore Gardens” around Clare Holland House have undergone a facelift and, although the garden is in its infancy, another decade will see growth that will enhance the facility by providing shade, beauty and grace; it will also attract a wider variety of birdlife than we enjoy at present.
 
Another initiative at CHH in recent years has been the development of a “room sized” gazebo made from Jarrah. This development attempts to meet the needs of the Aboriginal and Torres Straight Islander Peoples within our community; providing an open air space into which a hospital bed can be wheeled. The gazebo has electricity to provide light and allow equipment to be used. It also provides shelter in which patients and families can gather together. There is Indigenous art work on a nearby wall of the facility. The gazebo sits within the foreshore garden and has views up the river (shown above) and across the lake. It was inspired after a well-loved indigenous patient died at CHH; his greatest wish was to be outside.
 
The ACT palliative care service incorporates a 19 bed In-Patient Unit, the Home Based Palliative Care service and a Medical Consultative service that sees patients in their home, in the local ACT hospitals, in aged care settings and on site in the specialist clinic. The service is managed by Calvary Health Care ACT and CHH is the stand alone building that houses these services.
 
Clare Holland House is named after the first Clinical Nurse Consultant of the original ACT Palliative Care service. In Clare Holland’s day the service was community based and was managed by ACT Health. Clare Holland died from metastatic breast cancer over 10 years ago, but she is revered for the tireless effort that she gave, with others, to the establishment of palliative care services within the ACT in its formative years.
 
ACT PEPA commenced in 2003. Initially the aged care sector picked up and ran with the PEPA program in this jurisdiction. Today PEPA is reasonably well known within the ACT – especially in the aged care sector, however increasingly so in the acute sector.
 
With only one host site in the ACT there are obvious positives and challenges. The positives include the ease of access, promotion and communication. Working with one team allows tighter allegiance, understanding and team work. The ACT PEPA Manager is also able to personally meet with and participate in the mentoring process of the placements.
 
The challenge, however, is that the host-site in the ACT has no other specialist palliative care services in which to share the responsibility of education and student mentoring. Managing the workload and minimizing the burden on the host-site staff is a constant challenge. Despite this the staff at CHH are welcoming, generous and gracious to PEPA placements. They willingly contribute to workshop sessions; providing education, and sharing their knowledge and expertise with the wider health care community. Annette, the PEPA manager in the ACT, and the National team are truly thankful for their on-going support and enthusiasm in providing this service to the local health sector community.
 
Placements coming to CHH have a time-table of experience developed to meet their learning goals and their workplace roles. Generally, they have exposure to the In-Patient Unit, Home Base Palliative Care and The Canberra Hospital (TCH) Palliative Care Liaison Team. For those that would benefit, a tour of the radiation oncology unit at TCH is also organized. Placements usually attend a Palliative Approach workshop during their placement week and have access to the library at CHH. Experiential learning, educational workshop, researching, resource gathering and networking all contribute to an opportunity to self-direct the learning experience to meet individual needs while at CHH. The post-placement phase has the opportunity for personalized follow-up and in-service education sessions for organizations should they request it.
 
Clare Holland House is a unique facility, beautifully situated, and exemplary in their care of palliative patients, their families, and education to primary health care providers. Thank you Clare Holland House…..!
 
chh2
 
The involvement and effort of our host sites never goes unnoticed and we gratefully recognise that without their support and assistance the success of PEPA would not be what it is today.  One of our hardworking palliative care host sites is based at Sir Charles Gairdner Hospital and consists of nine team members, which include:
  • Consultant physician/Head of department;
  • Clinical nurse consultant;
  • Clinic nurse
  • Registrar;
  • Two social workers;
  • Occupational therapist;
  • Chaplain: and
  • Administrative assistant
The service is based in an acute hospital setting where the team deals with a range of complex cases on a daily basis.  Thoughts on PEPA and the benefits they have observed for the participants and themselves are expressed below by personnel from the host site:
Our team has really enjoyed being a part of the PEPA program and having participants spend time with us.  Since its inception three years ago, the program has worked really well and the participants all seem to enjoy their placement and gain a lot of knowledge during their time with us.
 
PEPA is a great program for the participants who are learning about palliative care, but it has also been valuable for us to learn from the participants.  We have found that we have learnt so much about the different regional areas, what services they have available, the number of patients they see, and also the types of palliative patients that access their services.
 
It has also been good to meet new people and gain an understanding of their various roles.  It has been positive in the respect that we now have a better understanding of what is happening in the regional areas, and it impels us to ensure we give as much information to the participants as possible, knowing that information normally takes so long to reach these areas.   The main thing that our team has taken away from participants is the need for us to pick up the phone and talk to country staff about palliative patients that we are sending back to them.
 
In addition, it has been good to develop links with the range of health professionals as we now find that the transfer of information when referring future patients has improved at both ends.  We quite often receive phone calls from past participants regarding a palliative patient, which in part is because the participant knows us and feels comfortable enough to call for a chat.
 
Also having such a broad range of participants is always a good reminder about how fortunate we are to work in a tertiary hospital.  We are very rare in that we have a huge pharmacy at our disposal, the full range of laboratory and imaging services and access to other specialist care if required, most of which can be quite a challenge to access especially if you work outside of the metropolitan area.
 
We look forward to being a part of the program into the future.

Townsville Palliative Care Centre is situated at the Townsville Hospital. Constructed with community support and assistance from the Queensland Cancer Fund, the Centre was purpose built and opened in 2009. It has a 15 bed inpatient unit with capacity for 20 beds in the future. The inpatient unit has 14 single rooms and three double suites each with views either to the mountains or a nearby creek. The gardens have a spiritual room and gazebo for outdoor activities. The Palliative care service has been in operation for over 18 years.

The Centre’s outreach service provides a consultancy inpatient and outpatient service for the Townsville Health Service District hospitals and community. The consultancy service also visits Cairns once a fortnight. To ensure 24 hours day, 7 days a week support for patients wishing to remain at home, a contracting organisation provides home nursing and equipment as part of the outreach service. . Patients are able to move seamlessly between the inpatient and outpatient service due to the coordination between the palliative care multidisciplinary team and the hospital and community services.The multidisciplinary team comprises of a Director of Palliative care, consultant, inpatient registrar, community registrar, SMO, occupational therapist, physiotherapist, dietician, speech therapist, pharmacist, Indigenous liaison officer, coordinator of volunteers, social workers, volunteers and nursing staff.

The Palliative Care Centre is actively involved in educating health professionals and the community through various forums. The Centre is situated beside the James Cook University, which allows students of all disciplines to have access to the Centre. Regular videoconferencing to hospitals throughout North Queensland also provides education to those unable to attend the Centre.PEPA placements are another opportunity for the Centre to provide education, with  placements from various settings, disciplines and areas of the State. The most recent have been from Weipa, Atherton, Bundaberg and Mount Isa. Participants that have attended for four to five days are GP’s, Residential aged care facility registered nurses, Indigenous liaison officers, Clinical nurses and Registrars. The participants have also been a great source of knowledge for the staff at the Centre as the provide information for what the main issues are in their community and the Centre team can provide support during their placement and on their return to their workplace.

It is honour and a privilege to have PEPA placements and be able to provide education and support to health professionals making a difference in various settings of care. By building partnerships and improving access to palliative care, we are strengthening an important part of  health services – end of life care.Debbie D’Urso
Nurse Unit Manager
Palliative Care Outreach
The Townsville Palliative Care Centre