Thank you for my recent PEPA placement as understanding of palliative or supportive care has improved.
It was interesting to note that just like me before attending the PEPA program my colleagues also thought of palliative care as being limited to the care given to the terminal and actively dying person. This view has now changed and we now know supportive and palliative care starts long before that stage. We now realise that all the patients under out care need supportive and palliative care considerations as they are living with a life limiting illness and a huge burden of symptoms and psycho-social problems which make quality of life poor.
Managing their symptoms and psycho-social problems as they arise through supportive palliative care improves quality of life.
We are now aware of when to refer a patients to the renal supportive care clinic (RSCC) and how to do it. As opposed to before we are now more inclined to refer patients to the RSCC and have already completed referrals.
Thank you so much for all you taught me over the last 3 days! I have learnt so much and I know it will carry over into my emergency nursing, it already has!!
First shift back in the Emergency Department (ED) and I have a home based palliative care patient referred in for nausea, we did bloods and scans and IVT, analgesia and anti-emetics. The patient had cholecystitis which we managed with IV medications and IV fluids, all while making sure the patient remained comfortable!
So yay ED for treating a palliative patient well.
Another patient on the same shift came in actively dying from the nursing home. The patient was seen by the palliative care team at the nursing home and a syringe driver had been commenced, the patient then had decreased level of consciousness at the facility and the son wanted them to call an ambulance.
Unfortunately the son wasn't told about the dying process or symptoms etc and that this was an expected outcome that her consciousness would drop etc. Because of my PEPA placement I was able to confidently discuss the end of life process with the patient's son, what symptoms to expect and the management etc. The son was then happy for transfer back to the nursing home and for comfort care only. Therefore thanks to PEPA I have already started improving palliative care in the ED!!
Upon completing Program of Experience in the Palliative Approach I have gained insight into a service that I was not entirely familiar with before undertaking this placement.
I feel this experience was very worthwhile as I am able to now understand when a client would be referred to palliative care and what palliative care can do to help support and assist the patient and their family/carer at end of life care giving quality of life.
Palliative Care is often an overlooked service as community are not aware or educated on how the service can help with end of life care. This service can help reduce hospitalisations by caring for the patient in community and assisting with end of life care in particular keeping the patient comfortable and out of pain so they can still enjoy good quality of life.
On this placement I was also made aware that there is an under representation of Aboriginal patients using Palliative Care in our local area on the Central Coast. This made me realise that I could help educate and promote this service to our Aboriginal community so that they are aware that this service exists and is there to help.
I was given education on this placement, as well, about Advanced Care Directives and Advanced Care Plans. I was not overly familiar with these documents and was happy to receive education so that I am able to pass this knowledge onto patients that I assist so that they are aware they can put these documents in place to help with End of Life Care.
I was exposed to both patient palliative care in a hospital setting and in a community setting. It was a great opportunity to see the way they both worked.
I was able to see a couple of patients that were newly referred and how an initial assessment with these patients was conducted in the community setting and how the palliative care service can support these patients through end of life care with pain management, Occupational Therapy and physiotherapy assessments to establish equipment to help patient at home, such as hospital beds, wheelchairs, ramps etc. Some of these conversations around end of life are difficult to conduct so it was a worthwhile exercise seeing how the CNS would discuss with patients.
I can take this experience back and utilise in my current role as Aboriginal Hospital Liaison. I am often dealing with patients, families and carers at end of life stage and now feel more comfortable promoting this service and educating patients, families and carers on ways this valuable service can help support and assist them.
I was extremely happy to be able to undertake this placement and learn more about palliative care, a service that would certainly be beneficial to patients entering end of life and offering quality of life to these patients. I am happy to advocate for patients to refer, register and utilise this very worthwhile service.
I would like to convey my sincere thanks for all the support I have received during my placement week from Tara and the teams at the Northern Area Palliative Care Services. I have really enjoyed learning about your service, and the skills and knowledge your team adds to it.
I would also like to acknowledge all of the people and their families, who are referred to your service and who were willing to share their stories and experiences with me. I am very appreciative and humbled by their generosity.
Some other highlights for me…
- The open euthanasia conversation shared in the round table forum and the thoughts and considerations around the voluntary assisted dying act
- The opportunity and absolute privilege to meet clients in the community to hear about their problems and observe the Consultants and Clinical Nurses who support them in their symptom management.
- The ward rounds with the inpatients at the LMHS with Dr Hans and Val who generously shared their roles and philosophies in palliative care along with the approach to very distressed patients and families and the reassuring manner you offered.
- To Dr Mil and the staff at the Modbury Palliative Care Unit, who included me in the team and the discussions and shared with me the strategies to engage in difficult conversations.
- To Cathie who shared the ‘Brilliance in evidenced based palliative Care’ project, her enthusiasm and energy was inspirational…All the very best Cathie.
- To Dr Holden for sharing some of his resources with me and for shouting me lunch…thanks David.
- To Tara for coordinating such a wonderful experience…
It is my plan to take the learning's from my experience and share this with the Renal Supportive Care Project , link into the palliative care services in Gawler and share my experience with renal unit I work in at Gawler.
Kath Hampel (RN), Gawler Health Service
I spent three days observing the palliative consultancy team at a metropolitan hospital and two days in the community. While in the palliative care consultancy team I was invited to attend their “Soul Bowl” session. This is where all members of the consultancy team including consultants, registrars and nurses meet weekly and “debrief” on patients that have passed away. A symbol is placed in the bowl as a way of remembering that particular patient. A discussion takes place about each patient’s end of life experience and the team discuss what they did well or what they could have done better. I found this a really good way to remember each patient and improve practice.
Following my PEPA placement, I introduced a “Bowl of memories” following the same concept. It is brought out at our regular palliative meetings. This helps our team debrief and this is a great way to have a chat about our experiences with each resident who has passed away. Some of our residents are with us for a couple of years and many different people have their own personal experiences with them. I have found that I now get a lot more staff to the palliative meetings including allied health, hospitality staff, lifestyle staff, nurses and chaplains. We quite often have tears and a laugh and the feedback I have had from all staff is very positive. The bowl of memories sits in our reception area for all to see. Many family members have asked what it is and when I explain it they think it is a great idea that each deceased resident is remembered and respected.
Thank you for the opportunity to have a PEPA placement as if I hadn’t done it this would not have happened. I thoroughly enjoyed my placement.
At the commencement of my nursing career I was in a ward that dealt with a vast number of patients, some of whom were patients with a life limiting illness. Whilst confronting, this area interested me greatly. I found that as a nurse I had the ability to advocate for these people and dramatically impact on their quality of life. I learnt most of my palliative care skills by simply being in a situation where it was essential that I pick them up – wither by working things out for myself or watching and consulting with more experienced clinicians. I decided that to give my patients the best possible care it would be beneficial to undertake a PEPA placement.
The week I spend working in palliative care was challenging, surprising and highly educational. I was able to work with the community nurses whilst hey made home visits to their palliative patients and was able to spend time with the palliative care clinical nurse specialist as she made home visits and did hospital consults. The vast difference between working in the hospital compared to visiting people in their own home surprised me. I suppose the big difference is that in the hospital patients must abide by our rules and schedules. In someone’s home the experience seems much more personalized. We are in their space and must abide by their rules. As a nurse it is refreshing to be able to sit down in a patient’s home and really get to know them. The people we visited always welcomed us into their homes and seemed genuinely happy to see us. This is a reflection of the excellent work that the team does and the relationships they maintain with their clients.
The story of one particular family provided me with much to reflect on. Along with the clinical nurse consultant I was visiting a woman in her mid-forties who’d been diagnosed with end stage liver failure. We visited every day and I was able to meet her children, also her carers, and form a relationship with them. Members of the extended family were also closely involved but unfortunately did not have a relationship with the patients’ children. This posed an issue for the palliative care team. Both sides of the family had different views about the type of care that should be provided. They also commonly refused to be in the presence of one another. The palliative care team had to act as a mediator and facilitate family discussions whilst also advocating for the patient. Naturally, emotions were high and I was able to witness the CNS counselling each member of the family and ensuring the environment remained safe and the needs of all family members were met or negotiated. Her communication skills were unbelievable and she managed to keep all parties content.
On my last day of placement, just after midday, we received a call from our patient’s son stating that she had stopped breathing. The events of that afternoon delivered two significant lessons. Firstly, I put into practice the communication skills I had been learning all week as the CNS and I moved around different family members and provided comfort to them both by listening and counselling. This was challenging but I found that mostly the family members just wanted someone to listen to their stories and I was more than happy to lend an ear. Secondly, I was confronted by the extreme difference in emotion I felt being in the home of someone who had just passed away with their family as opposed to the same scenario in a hospital setting. It all felt so raw and I really felt the grief of the family. I spoke to my facilitator about my feelings in this situation. As I have mentioned above, being in someone’s home makes the experience feel all the more personal. I really learnt a lot from this experience in particular, specifically about how to look after the family of a patient and how to look after myself.
There were several other lessons that I learnt from my week in palliative care. My knowledge of the symptoms associated with end of life illness and their treatment increased markedly. My communication skills, particularly my ability to discuss death improved. I learnt about the pathophysiological aspects of many diseases, especially cancer. Also, and very importantly, I made contact with various other health professionals and found resources that I didn’t know were available to me. I now have a clear picture of where the palliative care team fit and when it’s appropriate to refer patients to them.
My week in palliative care was extremely rewarding and I am very grateful for the experience. The lessons that I have learned will help me in caring and advocating for my patients with a life limiting illness. I would recommend a PEPA placement to any health care professional that has contact with palliative care.
My name is Sally Eves and I work as a Senior Social Worker for the Kimberley Palliative Care Service and I am employed to cover the whole of the Kimberley in a part time capacity!
Palliative care in the Kimberley has the same issues that affect people in the Northern Territory - for example the high incident of renal disease and death, the tyranny of distance in obtaining general medical and specialist services and the challenges of delivering palliative care to aboriginal clients in a culturally sensitive manner. For these reasons, I requested a PEPA placement with the Territory Palliative Care service situated on the Royal Darwin Hospital campus and I was lucky enough to secure a placement in February this year. Whilst my PEPA placement was based in Darwin, placements are usually conducted in your own state, and are organised by the PEPA Co-ordinator for (your state or territory).
On Sunday 17 February I flew from Broome to Darwin to meet up with (Mentor A), my social work mentor and supervisor, for a whirlwind 3 day placement. My introduction to this dynamic team began with my attendance at a staff meeting. Later, I met with many of the key staff on an individual basis to discuss their roles and to see them in action during case conferences, clinic reviews and teleconferences with remote clients.
One of the highlights of my trip was meeting Bev Derschow who developed and designed the Northern Territory Aboriginal Palliative Care model (see link below). Bev was able to share her experience in ‘spreading the word’ about palliative care and how finding the ‘right’ person to talk to when conducting a family meeting is imperative to culturally appropriate practice.
I learnt that the Territory Palliative Care is a specialist program which provides a consultative service throughout the Northern Territory for clients with a life limiting illness. TPC is multidisciplinary and, while there are differences in staffing in Central Australia and the Top End, the full team includes specialist physicians, specialist nurses, social workers, occupational therapist and a pastoral care worker and volunteers.
During my placement I especially enjoyed meeting with the Pastoral Care Worker, the OT and, of course (Mentor A), one of the team of two Social Workers who provide services to inpatients of the Royal Darwin Hospital, people dying in the community and patients at the eleven bed hospice facility on site.
On my last day of my placement, I was also given a tour by Guam of the ‘state of the art’ Allan Walker Cancer Centre which provides the latest radiation and chemotherapy treatments for patients, reducing the need for lengthy interstate travel for the majority of NT cancer patients. I was happy to learn that this centre has the capability to accommodate patients from the Kimberley and that this may become a possibility in the future.
I can enthusiastically recommend a PEPA placement to anyone and I encourage you to contact the PEPA Co-ordinator (in your state or territory) to discuss the details about applying for a possible placement for yourself.
Senior Social Worker, Kimberley Palliative Care Service.
I graduated in medicine in 1963, worked in the country for ten years before taking up practice in Collins Street for 22 years. In 2002 I began at the Rosebud Hospital Campus of Peninsula Health where I was initially the Clinical Supervisor of the Emergency Department. When the inpatient complexity expanded I moved into the inpatient wards and am now Site Medical Director of the Rosebud Hospital.
At Rosebud I was confronted by the palliative care of terminally ill patients sometimes from diagnosis until death, but mostly as referrals from the community for the end stages of the disease. We are under the direction of the Palliative Care Team of Peninsula Health led by Dr Brian McDonald who is of enormous help and support. Being the oldest medico in the hospital my advice is always sought by the caring relatives on the progress of their dying relative/friend and so I felt it was important to improve my skills in all areas of palliative care in order to up-skill the junior doctors and enhance the capabilities of our small Palliative Care Unit.
The Victorian PEPA program is very capably run by Ellen Sheridan. I enrolled in the four day PEPA program at Peter MacCallum Cancer Centre, East Melbourne. It involved pre-course reading, lecture attendance, multidisciplinary meetings, attendance at consultancy ward rounds and ensuing discussions regarding care, one on one discussions with palliative care physicians, education on the use of opiates and other non-narcotic substances in pain relief, counselling techniques with patients and relatives, and the full understanding of palliative care in all circumstances and religious settings.
On completion, I felt much more confident in my ability to perform palliative care on my patients and to fully support and inform the concerned relatives regarding the process, the progress and the great value from this end of life supportive treatment.
In 2011 I used my sabbatical term at the hospital to gain further experience in palliative care at St Vincent’s Hospital, Melbourne and Caritas Christi Hospice, Kew. The latter is also an educational facility for professionals doing a post-graduate palliative care course.
The benefit I have gained from my PEPA program and the sabbatical in palliative care is greater confidence in performing the palliative care of an accurately diagnosed and prognosticated patient in all aspects of their palliative care pathway. I can confidently explain the pathway and objectives of the pathway to concerned relatives and friends and take the responsibility of prescribing appropriate medications. I believe I am now able to both empathise and sympathise with these situations and act in a better way as a true patient advocate in their proper care. I would definitely recommend the PEPA program as an excellent, interesting and informative program for all GPs.
Rosebud Hospital continues to offer palliative care services (inpatient) in the region of an ageing population. Public transport is not at all user friendly and so our grieving elderly patients have great difficulty in attending the palliative care centre in Frankston and I see this increasing considerably in the coming years. Dr Brian McDonald continues to provide us with great consultant advice from his Golf links Road Unit and attends us when requested.
(Reproduced with permission from Dr Richard Ward and the Peninsula GP Network)
I commenced my PEPA placement on the 19th July 2011. My first two days were spent at St John of God Murdoch Community Hospice. All the staff were very friendly and welcoming. I worked with the same Registered Nurse over my two days and saw lots of aspects of Palliative Care. It was very interesting and I learnt so much during my placement at the hospice.
My next day was spent at Silver Chain with a Murdoch based Registered Nurse. Here I got to experience how Palliative Care is applied in the community and the support available in Perth.
My last day was spent at Royal Perth Hospital where they have a Palliative Care Team that visits patients on the wards. I joined the Medical staff on their rounds and found it very interesting. In the afternoon I joined the nurses for an in-service lecture on “end of life issues with renal failure patients”.
In conclusion I thoroughly enjoyed my PEPA placement. I gained a lot of knowledge from it and I would encourage other people interested to apply for the program. And can I say that due to my positive experience at St John of God Murdoch Hospice, I am now employed there as a Hospice Registered Nurse and I love it!
AJ is an Aboriginal woman who works as a Personal Care Worker in aged care in remote western Queensland. She undertook a split placement spending time with two host sites.
“Palliative care is very valuable, we only get one chance to get it right. Whether people choose to die at home or in a hospital or RACF the emphasis is on providing good quality end of life care and having the knowledge and confidence to carry it out effectively. These placements provided me with a greater insight into all aspects of palliative care in different settings and social situations, the care of the client, the family and the carers. I was very much out of my zone in Brisbane however the support I received the entire time of my placement from the PEPA team and in particular the PEPA Indigenous Project Officer Darryl was invaluable. I was welcomed to Karuna with genuine warmth and was on the road with RNs doing home visits. I was encouraged to ask questions and I sat in on case conferencing learning the benefits and positive outcomes of this as a way for the multidisciplinary team to touch base and problem solve. I feel privileged to have been placed with Kris the Nurse Practitioner at Metro South. She was more than happy to share with me what she knows and ignited in me the desire to learn. With her I visited aged care facilities and (learned more) about family conferences. I strongly recommend PEPA for managers, nurses AINs/PCAs as it provides professional skill development on all levels.”
Melissa Willson is a Senior Registered Nurse, working on both the oncology and medical wards, at an ACT Private Hospital. She participated in a PEPA placement from the 15th to 19th November, 2010.
As a registered nurse working in an acute care hospital, I often care for those in the palliative stage of their illness. Previously I have attended short courses and in-services, each giving a glimpse into an aspect of palliative and end of life care but I have never before undertaken a holistic, practical and experiential course such as PEPA.
Last week I was privileged to spend a week based at Clare Holland House in Canberra undertaking a PEPA placement. I spent a day in each of: orientation/overview, inpatient unit, community based palliative care, palliative care team at a large public hospital and aged care palliative outpatients. Every day was very different and the experiences gained in each environment insightful and invaluable.
My expected goals of learning of the PEPA placement largely encompassed physical care of people with life limiting illnesses, but my actual outcomes were much more diverse. Whilst adding to my knowledge of how to physically care for those coming to the end of their lives, I also experienced a totally holistic approach. This is the approach we aspire to provide in the acute care setting but one which is frequently suboptimal, and which often only caters for medical and nursing care. During my placement I witnessed truly holistic care which was demonstrated at case conferences where all inpatients and some outpatients were respectfully discussed by each member of the team, doctor, nurses, pastoral carer, social worker, occupational therapist and the co-ordinator of volunteers. Previous plans for managing difficult issues arising from previous meetings were reviewed and new strategies put in place. I have never seen a multidisciplinary team work so well together striving for the best possible treatment of those in their care.
Experiences I also gained in other areas foreign to my usual clinical practice (i.e. home based and aged palliative care services) widened my knowledge base and added to the brief but thorough palliative care exposure I received during my placement.
Having completed my PEPA programme, I feel I am better skilled to care for those with life limiting illnesses and now also have contacts in specialized palliative care services to liaise with when I need advice about assisting people in my own workplace. Ultimately the skills I learned and the resources I now have can benefit those in my care.
I thoroughly enjoyed my week of PEPA and would encourage other health care workers to also do the course.
Thank you to the PEPA ACT team and all the ACT palliative care team for a fabulous and worthwhile week.
Starting at 9:30am, I met with the SA PEPA Project Manager Mrs Peta Jackson who took me to The Royal Adelaide Hospital to meet with my mentors. I was feeling excited about doing a palliative care placement but then again I was nervous about meeting the team from Adelaide Palliative Care.
My mentor, Rhapsody (palliative care nurse), explained the roles and responsibilities within the palliative care team and the role of the team out in the community. That first morning I spent a few hours with her visiting patients on various wards. I hadn’t realised that patients with all illnesses could be referred to the palliative care team; I thought that only patients with cancer had access to palliative care. Rhapsody was very nice and explained nursing notes and broke it down to the terminology that I could understand.
I was able to meet some of the patients and was truly blessed to see how Rhapsody interacted with the patients. She was soft spoken, gentle and caring. I noticed that she also allowed time for the patient to talk and ask questions. This is important when dealing with our mob as we need to allow time and space for questions or reflection.
During my time in Adelaide I was also able to visit various Aboriginal Services and the step down unit. This was good to see where our mob can go when they come down for appointments. I learnt that it all starts by finding the right time and place and getting the discussion happening. As health workers we need to gain some confidence and the only way we can do this is through education and support.
The day and week ended with an evaluation form for me just reflecting on how my week at the Royal Adelaide Hospital went and also to talk about what I have learnt and what I can do as an Aboriginal Health Worker. This PEPA placement enabled me to network with people from different agencies within the palliative care area and enabled me to put names to faces as well as gain knowledge around palliative care. Overall, I enjoyed Peta’s company throughout my placement and with the support from her and the entire experience I will be better able to assist a client or loved one as they go through their final stage of life.
Geraldine Mc Namara
Senior Aboriginal Health Worker
Umoona Health Service, Coober Pedy
My PEPA placement came about because I have had a long term interest in working in Palliative Care and saw this as an opportunity to further my knowledge in this area.
I am a Community Health Social Worker based in Zeehan on the West Coast of Tasmania. This is a rural remote community. The West Coast is serviced by the North West Palliative Care team. The goals for my PEPA Training were;-
- To gain a broader understanding of the Palliative Care role.
- Expand my knowledge of the Social Work role in Palliative Care.
- To gain insight into what grief and bereavement supports are currently being conducted in other parts of the state
- To learn what training and educational material Palliative Care could bring to the West Coast.
My PEPA training was for four days split between two centres. One was in Burnie where the North West Community Palliative Care service is based, the second placement was in Hobart at the Community Palliative Care Service and at Whittle Ward.
In Burnie I was able to sit in on the community client meeting and observe the team discussing the various issues that arise within the Palliative Care setting. I also spent some time with Suzanne Wellesley, Social Worker, and gained further insight to the nature of the family support offered to clients. I was privileged to witness a young man, who is dying, make mementoes for his nephews. The joy he felt at his sense of achievement in completing these simple but powerful messages to his family was very moving. I was also present as Suzanne spoke with a woman who had mental health issues. This gave me further insight into how lifelong health issues can impact on families as a member is dying. Suzanne shared with me some of the ways that Advanced Care plans and Not for Resuscitation forms were written up. I find these confronting to read and write as they force us to consider the step by step process of disease degeneration and dying. Here I was also introduced to a strange beast called “Life Extinct” forms, this was the first time I had seen one of these.
Being in Burnie and spending time with Vicki Elphinstone (Manager) gave me time to discuss the scope of the Palliative Care role and start to flesh out ideas and information for Palliative Care training and educational material that can be bought to the West Coast.
Travelling to Hobart provided a very different experience. Being in a city is so different from the West Coast and the struggle to find a carpark and having my car fenced in by another car was one simple reminder. On the bright side I was able to spend time with Fiona Jones, the Community Palliative Care Social Worker, and Chris Batten the Social Worker on Whittle Ward. We discussed various topics ranging from working in Palliative Care teams and the social work role within the team, the nature of holistic care and what is a good death. I was also able to discuss the support offered to families through the “making a memento” activities and the remembrance services conducted for Whittle Ward.
Whilst in Hobart I met with Jenny Fuller, Hospice Care Coordinator and coordinator for the ‘Walking through Grief’ project and discussed with her how this volunteer supported walking group helps people through their grief. We also discussed the different memorial services that have been conducted for people who are mourning the death of a loved one.
I have some specific goals for what, HealthWest, can provide on the West Coast. These are to:-
- Increase the level of grief and bereavement support within the community
- Check, evaluate and update (where necessary) the type of Palliative Care resource material that is available on the West Coast for health workers and community members
- Work with NW Palliative Care and the local health workers to plan for further Palliative Care and grief and bereavement education for health staff on the West Coast.
My PEPA experience has provided me with the partnerships and information to enable HealthWest to achieve these goals.
Gordon Roberts, Community Health Social Worker
I am a Palliative Care Clinical Nurse Specialist, currently based in Orange (rural) NSW and for my 4 day PEPA clinical placement I was keen to see a couple of specialist units in the Sydney metropolitan area.
My first area of interest was Motor Neurone Disease (MND), and it was arranged that I spend one day at Calvary Hospital, Kogarah and one day at Prince of Wales Hospital. MND is a challenging disease and made more so in rural NSW. The disease is rare enough that health professionals across the board get very little exposure and therefore little experience caring for someone with MND. My goal was to see what services the city units offered their patients, and to see how that could be adapted to a rural setting.
The first day I tagged along with the vivacious Patsy Pynn – Social Worker in MND. I had met Patsy on a previous occasion and value her understanding of the implications of living with MND. With Patsy I visited 3 MND patients in a variety of settings and at different stages of their disease. Her patience and understanding is inspirational.
Day Two, and I was lucky enough to be in Sydney for the POWH monthly MND clinic. This involves a diverse range of allied health and medical personnel coming together once a month to see patients with MND. The clinic is coordinated by MND (guru) CNC Margie Zoing. In just a few short hours, I felt I could walk away having had my fill of the potential of what services we can offer MND patients. I was also inspired by the care and dedication of the staff I met there.
Day Three and off to Royal Prince Alfred Hospital for the first of 2 days there looking at the workings of a Radiation Oncology Unit. My interest in Radiation Oncology is partly driven by my ignorance in the field and partly because in 2011 Orange will have its own Radiation Oncology Department and I wanted to have a better understanding of the nurses’ role within a Radiation Oncology Department.
My first day at RPAH was spent for the most part following a man through his brachytherapy treatment (for Prostate Cancer). I was amazed at the amount of preparation and personnel involved for what turned out to be a 15 minute treatment. The amount of OH & S checking involved was impressive.
My final day, still at RPAH was mostly spent observing the role of the nurse. The lovely ladies there were very patient in answering all of my questions, and taught me some very basic but effective dressing techniques for skin reactions to the radiation.
I returned home having exhausted my poor brain, but very grateful for having had the opportunity to see and do so much in such a short time.
Palliative Care CNS
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 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.
My motivation to participate in PEPA arose from self-doubt in my ability to effectively care for the palliative clients in the community setting. I have been a community health care nurse for the past ten years and although I have been involved in the care of many palliative clients, I have often felt that I could do better in managing their needs. Another reason for my interest in PEPA was to explore the issue of self-care when involved in the care of palliative clients which can be emotionally draining. I recognise that self-care is imperative in order to avoid feeling stressed or emotionally overloaded.
My first placement during PEPA was with Community Palliative Care Service. My learning experience was assisted by attending home visits to both stable and unstable clients. Each client was assessed with an holistic approach and symptoms identified and managed. The next day on Whittle Ward I “buddied up” with a different RN. I attended a multidisciplinary meeting and it was obvious that each person present was solely concerned with the well-being of the patients and respected the others and their field of expertise. I also participated in the doctors’ round where each patients’ care was evaluated. This helped to improve my knowledge in symptom control and medications. I became more familiar with and more confident in the use of the Niki T34 syringe driver. My final placement was with the palliative care nurses at the RHH. I attended the weekly palliative care meeting which included the oncologists, RHH palliative care resident, a nursing representative from 1BS oncology, community palliative care nurses, oncology intern from Whittle Ward and social workers. The ongoing care and treatment needs of all palliative inpatients, as well as all community palliative clients known to the RHH palliative care team were discussed, enabling input from all involved in clients’ care to promote optimal care provision. It was interesting to observe the interaction between the disciplines and to recognise some of the community clients I had met previously. In the afternoon, I accompanied the oncology registrar on her round as she visited palliative clients, evaluating their ongoing care. I was impressed by her bedside manner which was both professional and relaxed and it was obvious that she has established a good rapport with her patients, taking time to listen to their needs and concerns. She involved me by encouraging me to discuss their care and I felt comfortable seeking clarification about medications and their use.
I have found the PEPA program to be invaluable, giving me insight into the hospital system and community provision of palliative care. My confidence has increased as a result of the knowledge I have gained. In each of the placements I was welcomed and encouraged to attain my learning needs. Resource material was supplied to provide further information. I would encourage all my colleagues to seek the opportunity to participate in this program of experiential learning. I am currently working on information I have gathered regarding self –care and compassion stress and will distribute it to the members of the Hobart Community Health Nursing team.
At South-West Health Care I was allocated a day each with three palliative care staff members. I accompanied the staff on home visits where it was appropriate and was introduced to people utilizing the support of the service. I was impressed with the level of care and the way it was provided. Staff showed the utmost respect for each individual and while treatment options were offered and explained there was a courteous grace that allowed each person the right to decide for themselves. Issues raised by clients were immediately addressed and staff made phone calls on the spot to ensure appointments were made with specialists and that arrangements were made for transport if needed. Medications were explained and reviewed and staff showed a thorough understanding of medications related to treatment of illness and pain. The stories of clients were listened to with staff assessing the need for clients to be encouraged to reflect on some of their statements in order to better understand them. It was clear that each staff member provided the time needed by each client and their family members.
The palliative care experience impressed on me the need to provide frequent opportunities for people dealing with loss of health and life to be heard. As Eric Fairbank (palliative care physician) explains, telling our stories and being listened to with respect enables us to build sense of self and confirms our humanity and dignity. I observed staff encouraging clients to be connected to family and activity that gave purpose. This provided recognition to me that the spirit of each person would be nurtured enabling a greater strength to journey a difficult landscape.Despite being within a hospital setting the McKellar Centre, Barwon Health experience was equally impressive. The response to pain management was immediate and every care was taken to support the individuals and families when death was imminent. Privacy and practical needs were attended to and every effort was made to alleviate suffering. Care plans were clear and specific to patient needs.
Thank you for the opportunity and support to be part of PEPA, it was a great learning experience and I am deeply respectful of the knowledge and care given to our community.
My name is Doris Mutie, I am a Kenyan by nationality. I am married with three beautiful daughters. I have lived in Canberra for about 5 years, after moving to Australia in 2006. My family and I enjoy living in Canberra because of its multicultural diversity.
For the last three years I have worked at Morshead home where I’ve grown very fond of the residents and my colleagues. In my time as an aged care worker over the last fifteen years, I have worked with individuals with life-limiting illnesses and have watched their families go through emotionally draining circumstances. Through these experiences, I became more interested in learning about palliative care.In April, I was privileged to take part in a four day PEPA clinical placement on a palliative approach, which was held at Morshead Home and organised by Sue Turner the ACT PEPA Manager from Clare Holland House. There were lots of learning experiences throughout the four days with plenty of things to learn within that period. Most importantly, the fact that palliative care aims at improving the life for individuals with a life-limiting illness and their families by reducing their suffering through early identification. I also learnt how to improve the quality of life of palliative care residents by making them more comfortable through using different ways of relief from symptoms and the importance of frequent assessments to ensure interventions being used are useful and that they do not cause unwanted side effects, and that they should be stopped if not benefiting the resident/patient. Another thing that came up clearly was the importance of providing generous amount of information supported by written resources to residents and their family members, and also the importance of not avoiding bereaved people and that companionship of family and friends is essential.
Workplace activities implemented post placement include:
• Better signage with big print available for placing on door - to be used with Palliative, particularly EOL, resident's. These signs are for directing visitors to staff, limiting time or number of visitors if required, stopping visitors walking in to room especially when something is happening for the resident (eg spending time with a loved one, time with minister, etc)
• Resource folder with plenty of palliative information, with information for staff, resident and family members. Located in nursing station.
• Alteration of pain charts to enable AIN's to record pain and a section for completion by them if an RN or EEN requires notification. (chart only if no pain, chart and report if pain)
• Education of AIN's regarding above use and other aspects of palliation pertinent to their scope of practice.
What I learnt has helped me to be able to face all work situations with more confidence and the materials compiled have helped other staff by improving the care provided to the residents with life limiting illnesses. It has also helped with providing more information to the families on how to cope with issues of terminal illnesses.