Reflections by a palliative care nurse on the COVID-19 frontline

As I start to return to my usual role, I wanted to take some time to reflect on the last couple of weeks and acknowledge and thank the vast number of people in Canterbury DHB who have poured countless hours in to supporting the patients, families and staff of Rosewood Rest Home and Hospital.

I volunteered to be redeployed in the COVID-19 hospital ward at Rosewood. I worked 60 hours over seven shifts as a palliative care clinical nurse specialist.

It is still hard to describe the situation we were faced with. Firstly, we changed into scrubs in the clean area, then got into our personal protective equipment (PPE) in the transition zone (under the watchful eye of our fabulous PPE champions). Then it was brief introductions to those who would be our colleagues for the day (registered nurses, enrolled nurses, student nurses, theatre nurses, paramedics, dental nurses and caregivers, all redeployed from other services) and straight into the ward. From there, it was all hands on deck to keep up with the never ending tasks of caring for elderly, sick and fragile patients, whom you’ve never met before.

Meanwhile your brain clouds over until your lungs adjust to breathing through a mask, becoming increasingly breathless with every shouted conversation to an unidentifiable colleague. Patients’ symptoms would flare up, with little to no predictability or recognised pattern (yet) alongside other underlying health issues presenting their own symptoms. Diarrhoea, back pain, dry cough, delirium, the occasional temperature, lungs filling up fast with thick mucous and decreasing oxygen saturation that betrayed the underlying seriousness of their illness. For some, positioning became a matter of life or death.

Everyone worked tirelessly in the built up heat of PPE to keep up with the heavy nursing tasks required, while still taking time to fuss over the personal touches for each patient, like finding the right station on the radio or singing happy birthday complete with a little cake and candles. Gloved hands struggled to make the touch-screen of the electronic drug chart or smart-phone work, or to type the right letters into patients’ electronic records for the GP to read remotely.

Fortunately, after the initial onset of acute symptoms, most patients appeared largely untroubled by the roller-coaster of symptoms that lingered as days turned into weeks. It seems to be the one positive in all this, on their bad days they would just go quiet, refuse food and fluids, tuck up in bed and sleep peacefully. But this is when we worried about them the most.

The most heart-breaking of all of this though will always be the inability to unite families with their loved ones in their time of need. I cannot imagine the worry and fear this must cause, despite our best efforts to keep in touch by phone or video call. Dying and death are so steeped in our social rituals and traditions. Not being able to be there with them, and not being able to accompany other family members during funerals and the grieving process will, I’m sure, leave many lasting scars. Families just hoped we could get their loved ones through the illness until they were able to be with them again, come what may. We tried, we really did.

Meanwhile, on the other side of the glass door separating us from the outside world, we could see many others working equally as hard. Deliveries arrived; a constant stream of clean linen, more scrubs, boxes of PPE, equipment, food for patients, food for staff, medical supplies, gifts for Rosewood from neighbours and industry colleagues, all of which we were using as fast as they arrived. More staff arrived, ready for induction in to their new roles as receptionists, cleaners, administrators, or to receive training on the use of PPE in preparation for work within the clinical areas. Beyond that, there were security guards who stood alone on the footpath in 10-hour shifts.

Unseen but greatly appreciated, was the Canterbury DHB Emergency Coordination Centre (ECC) team that coordinated us all and devoted themselves to ensuring the smallest details were accounted for. I cannot begin to imagine the mammoth task of staffing and operating an aged care facility in the throes of a pandemic, and all from afar. But what I can say is that I’m deeply grateful to each and every person who sorted their piece of this giant puzzle and kept us all safe. The residents at Rosewood may be elderly with many suffering advanced, long-standing illnesses that render most unable to communicate, but they still delight in their favourite music or their favourite meal. They could still let me know where to stick my thermometer when they were tired of being poked and prodded. They were once soldiers, teachers, mothers and athletes and they still matter deeply to their families, to the Rosewood staff and to those of us who only met them briefly. I will be forever grateful to, and proud of, all those who honoured these people by going above and beyond the call of duty to do everything possible to care for them.

I am also humbled by the continuation of care for those of us who stepped in and out of Rosewood. I received phone calls and multiple emails from ECC staff preparing me as best as possible for the role (although in truth, it was more intense and heart-breaking than I could have possibly imagined), as well as phone calls and emails from occupational health now that I have finished my work there; making sure I am ok and that I am clear about the services available to me and what is required in the weeks ahead as I return to my usual role. Having unrestricted access to a full range of PPE during my work, as well as health assessments and swabs on completion, has been a significant psychological support throughout, and has enabled me to feel confident about my safety at work. One less thing to worry about in this extraordinary set of circumstances. Thank you.

I would also like to acknowledge the often unsung heroes of our health system; the staff working in aged residential care. Without knowing anything about the residents when I arrived, it was still very obvious that these people were not just well cared for, but loved. The little messages left around the place signalling to others that ‘Bob’ likes fruit with his Weet-Bix but ‘Nancy’ hates mushy carrots, the smiling faces in photos on the wall of outings with staff. I know they were deeply distressed by having to leave their patients, heart-sick when hearing from afar about the devastation COVID-19 was wreaking on those they consider family, and completely lost when returning to a workplace so unrecognisable and with many missing faces. For sure we will have put things in all the wrong places and missed filling in a few forms, but we did our best to replicate their love and care of patients in their absence. The smiles from patients on their return told us they were greatly missed though.

No doubt it will take a long time for the Rosewood community to pick up the pieces and move forward. I hope we will all continue to offer them the support and resources they need.

With my most humble gratitude for all the mountains that have been moved by many in recent weeks,

Jo Hathaway

Regional (South Island) Programme Facilitator – Palliative Care
South Island Alliance Programme Office

[This article was first published as “Reflections from Rosewood” on the South Island Alliance website in May 2020. Reproduced with permission.]

Summary of WHO Mask Guidance Article released on 06/04/2020

Hi everyone,

I summarised this latest article from the WHO for my workmates.

COVID-19 is transmitted by:

  1. Droplets coughed or sneezed out
  2. Close contact – within 1m

Incubation period (Time from exposure to symptoms developing) = Pre-symptomatic period is average 5-6 days, but could be as long as 14 days (hence self-isolation period of 14 days recommended by MOH)

Pre-symptomatic transmission possible but person would be coughing or sneezing to produce droplets, and contaminating their surface surroundings.

Non-Medical masks (Do It Yourself), e.g. cotton masks, no current evidence to support or not support use. One study of health care workers using cotton masks showed that they were at increased risk of infection compared to those who wore medical masks.

Medical masks:

Should be reserved for health care workers.

Masks by themselves – Not adequate protection. Continue reading

#PalliCOVID #PallANZ tweetchat 7/4

#PalliCOVID #PallANZ (3)

Please join us for another tweetchat on Tuesday 07/04/2020 to discuss palliative care in Australia and New Zealand during the COVID-19 / novel Coronavirus pandemic. Find out from special guests Prof Meera Agar @meera_agar (Board Chair of Palliative Care Australia @Pall_Care_Aus) and A/Prof Leeroy William @drleeroyw (President of the Australian and New Zealand Society of Palliative Medicine @ANZSPM) what has been happening in this space since our last tweetchat – and share your experiences and resources with other palliative care practitioners from across our region!

When?

Who?

  • Palliative care clinicians, researchers, managers, policymakers, patients and carers
  • Interested / involved in helping our communities live, die and grieve well in the face of the life-threatening COVID-19 / novel Coronavirus pandemic
  • Living or working in Australia and New Zealand

How?

What?

  • Topic 1: Social distancing rules (e.g. restricting visitors & limiting funeral gatherings) have changed the way we care for the dying & grieve for the dead. How can we help patients & families to live well, die well, grieve well AND flatten the curve?
  • Topic 2: Telehealth and working-from-home poses unique challenges to a touchy-feely, team-based specialty like palliative care. Please share a story about how you’ve adapted (or not!) to these evolving work practices.
  • Topic 3: Meera & Leeroy – can you please give us an update on the work of the Australian COVID-19 Palliative Care Working Group? Does anyone else have any updates / policies / resources that they would like to share?

We hope you can join us for another great discussion!

 

#PalliCOVID #PallANZ tweetchat 23/3

#PalliCOVID #PallANZ

Please join us and other palliative care clinicians from across Australia and New Zealand on Monday 23/03/2020 for a tweetchat on the COVID-19 / novel Coronavirus pandemic.

When?

Who?

  • Palliative care clinicians, researchers, managers, policymakers, patients and carers
  • Interested / involved in helping our communities live, die and grieve well in the face of the life-threatening COVID-19 / novel Coronavirus pandemic
  • Living or working in Australia and New Zealand

How?

What?

  • Topic 1: Please share a story about your #COVID19 #Coronavirus experience so far – at work, at home and/or online
  • Topic 2: Have you come across any useful #COVID19 #Coronavirus resources that others might find helpful?
  • Topic 3: How can we look after ourselves and each other during the #COVID19 #Coronavirus pandemic?

We hope you can join us for a great discussion about this global public health challenge!

 

Palliating in a pandemic

It’s hard to overstate the impact of the novel Coronavirus on health systems around the world. It’s particularly poignant for palliative care workers, so familiar with dying, to imagine the loss and grief. We try to image what it could be like for health care workers at the front line. Soon we will not have to imagine, as we will be at the front line.

This article, written in 2010 about influenza by Dr Downar and Dr Seccareccia, is prescient.

Twitter as always is an invaluable source of dialogue on this issue. Try out this thread    from @AmitAryaMD  – you don’t need to be able to use Twitter to read it.

How are your teams and health care service preparing for the pandemic in Australia, New Zealand and elsewhere?

 

 

Study shows why cancer patients are asking for medicinal cannabis

I can tell you, it’s true! Many cancer patients are asking their clinicians for medicinal cannabis – but worryingly,  around one in four patients believing it will help in control or cure the cancer, a Victorian study has found.

This study was carried out by a team at the Victorian Comprehensive Cancer Centre and Parkville Integrated Palliative Care Service, lead by Dr Stacey Panozzo, investigated the characteristics and medicinal cannabis requests of 1700 patients with breast, colorectal, melanoma and oesophageal cancer patients attending the three centres over a six month period in 2018-2019.

The study was also featured in this Limbic Oncology article.

Continue reading

Inspired to improve your communication skills?

 Cancer Council WA delivers the very successful workshop on communication skills training, perfect for the situations described in our article earlier today.

For more information in WA see here

Cancer Council Victoria also has a variety of education and communication workshops and resources.

Know a great resource for communication skills? Comment below.

Continue reading

Palace of Care – In his arms

mayur-gala-487-unsplash

Photo by Mayur Gala on Unsplash

It had been a great game of football, they had managed to successfully complete a number of moves that they had been practising for weeks. He was proud of the fact that the ball was always safe, in his arms.

The post-match party was a happy and raucous affair, a swirl of colours and noise, but everything seemed to stop, when she walked into the room.

Their eyes met across the crowded space, everyone else became invisible and they instantly fell in love. Soon she was, in his arms.

Fast-forward 23 years to an admission into our family room. Again a swirl of colours and noise as they settled into the room with their seven children, and their children’s children.

Early on in their relationship they had reflected on their own upbringing, having being raised by their grandparents, they made a pact that they would raise their own kids themselves.

And they did so over the next 22 years which were filled with joy.

She had become unwell over the past year, needing many trips to clinics and hospital for many treatments and even more disappointments. Always supported by their family  who stayed strong around them.

It had taken a lot of convincing to allow Hospice into their lives – he was scared of them – but the fears were soon allayed by the visiting staff.

Barely three weeks ago she had organised a family trip up North, just them and their four youngest children. “She knew that her time was short, and that was her preparing me.”

During the weekend, he had shared, “Thank you for providing this large room for us, it has allowed me to be the husband again, and the father to my kids, we can be ourselves again.”

There were many visitors over the weekend and into the new week.

On the very last night the couple were together, peacefully in bed, surrounded by the love from all their kids sleeping on the floor around them.

Coming back from the bathroom on the final morning, held up in his arms, “I think it’s my time to go.”

Gently back to bed, still in his arms.

Feeling safe, surrounded by the best things in the world, their kids and grand-kids.

She leaned back, in his arms, and then quietly left the room.

“She was looking after us all, right until the very end, giving us the strength to carry on walking tall.”

Conversations with patients in palliative care by Dr Matthew Grant

Dr Matthew Grant, a palliative care specialist, has published this article in The Conversation describing normal conversations in the course of his daily work.

I love the way he sensitively maneuvers through difficult conversations, allowing the patient to control the content of prognostic information given.

   “Not everyone will feel comfortable talking about their future treatment plans like Keith. It’s important I allow Sharon to decide whether or not she wants to talk about a future where she dies, just as I shouldn’t necessarily dissuade Christos from smoking if it gives him pleasure.”

Continue reading

webinar – palliative care in hospitals 17th October 2PM AEST

Interested in palliative care in hospitals? I certainly am. In my work as a palliative care consultant in the consultation service in an acute hospital, I see a LOT of unmet need, late referrals, and treatment being undertaken without good conversations about the patient’s goals and needs.

We at Palliverse are very keen to promote improvements at a systems level to improve access to palliative care in the acute setting.

On 17th October, Safer Care Victoria is holding a free webinar on palliative care in hospitals. Our host is Claudia Virdun, who has worked in palliative care within a clinical, project management or education position for over 18 years. Claudia has completed an Honours degree (Nursing), Masters degree in Advancing Professional Healthcare Practice and is currently a Phd Candidate with her research focusing on supporting system-level improvements for palliative care within the hospital setting.

Pre-reading for the webinar include Ms. Virdun’s review and meta-synthesis on what is important to patients and families in end of life care in hospitals.

The webinar takes place at 2PM on 17th October AEDT. For those outside of eastern Australia, here’s a time zone converter.