My application to complete a PEPA placement stemmed from an interest to gain skills and knowledge in areas of Occupational Therapy (OT) practice to assist with expansion of the role within the new Palliative Care Centre (pictured), a 20 bed facility to be opened attached to the Townsville Hospital (TTH) in October, 2009. I also hoped to observe and experience the dynamics of another Palliative Care team and their application of the Palliative approach.
Currently the OT role at TTH is restricted to discharge planning, equipment prescription and occasional oedema management within the confines of a 0.5 position for both inpatient and community. When the Palliative Care Centre opens we are aiming to expand the role to include a focus on non-pharmacological symptom management targeting areas including fatigue and breathlessness with a potential focus on the provision of strategies to assist with energy conservation, relaxation and occupational performance.
On my one-week placement I was fortunate to be supervised by a highly experienced OT who had worked in palliative care extensively throughout his career. The main areas of learning included palliative care service provision (including community integration of non-government services), the OT role within a palliative care inpatient ward and in the community setting (specific assessments and intervention) and the multi-disciplinary models of practice within the Gold Coast Palliative Care Service (host site).
The key aspects of my learning came from discussions with my supervisor/mentor regarding opportunities for expansion of current services to include a more holistic model of care, for example:
- High level oedema/lymphoedema management
- Introduction of group/individual programs for non-pharmacological symptom management
- Benefit of therapeutic creative expression
As a result of my PEPA placement I have engaged in two activities upon return to my workplace. Firstly I had the opportunity to provide feedback to the Palliative Care Team in Townsville regarding the following:
- Dynamics of the Gold Coast Palliative care team (including staffing, resource allocation, assessments, outcome measures),
- My experience of the inpatient facility/community setting and the Hopewell Hospice (including admission criteria, staffing, format of meetings etc)
- Gold Coast team’s interpretation of the tertiary model of practice
- Development of service specific resources
The aim of this feedback was to generate discussion of our own service and evaluate our current practices in comparison to a service with similar systems and procedures.
The second activity involved the OT department at the Townsville Hospital initiating a project team (pictured) to complete a large quality project with an aim to expand the current service provision of the OT working in Palliative Care in anticipation for our new Palliative Care Centre opening. I am co-coordinating the project which is taking the direction of benchmarking with other facilities regarding programs and interventions (specifically regarding non-pharmacological symptom management strategies currently in use) and literature searches establishing documented evidence of the specialist OT roles within these areas of practice.
Links have been initiated by our OT project team with major facilities providing Palliative Care in Australia and the UK to establish contact regarding current resource development and program implementation in relation to the extended OT role within the palliative care field. I am also utilising information provided by my supervisor/mentor from the PEPA placement to assist with researching for the project and with providing an expert network base to assist as the project continues. We are hoping that the project will extend to further research post implementation of the new programs and practices to evaluate the impact of our interventions. Communication with other palliative care facilities has also been established to consider allocation of resources (both for OT and other elements of the service) and the use of outcome measures (i.e. PCOC outcome measures), to ascertain where resources are directed and allocation of staffing.
The overall PEPA experience has been beneficial to service delivery by highlighting the importance of a collaborative approach to care provision and demonstrating the need to consider the interpretation of a tertiary model of practice. Personally, the placement was an opportunity to further develop knowledge and skills to assist with the expansion of the OT role within the new centre and has been instrumental in providing directions for further research. This experience has validated for me the need to realise the full potential of the OT role within a palliative care setting to provide holistic and patient focussed care.