Participant Reflections
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Melissa Willson, Senior Registered Nurse
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.
Melissa Willson
Geraldine McNamara, Senior Aboriginal Health Worker
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
Gordon Roberts, Community Health Social Worker
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;-
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To gain a broader understanding of the Palliative Care role.
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Expand my knowledge of the Social Work role in Palliative Care.
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To gain insight into what grief and bereavement supports are currently being conducted in other parts of the state
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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:-
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Increase the level of grief and bereavement support within the community
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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
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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
Louise Hoffman, Specialist Palliative Care Nurse
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.
Louise Hoffman
Palliative Care CNS
Orange
Kellie, Occupational Therapist
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:
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High level oedema/lymphoedema management
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Introduction of group/individual programs for non-pharmacological symptom management
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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:
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Dynamics of the Gold Coast Palliative care team (including staffing, resource allocation, assessments, outcome measures),
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My experience of the inpatient facility/community setting and the Hopewell Hospice (including admission criteria, staffing, format of meetings etc)
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Gold Coast team’s interpretation of the tertiary model of practice
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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.
Occupational Therapy Palliative Care Project Team
The Palliative Care Centre – under construction