International opioid conversion survey

The team at MD Anderson ask

Are you a #palliative care provider who prescribes opioids, performs opioid rotations and conversions? If so, please take our 5-10 minute survey to help us with our study. #HPM #HAPC #PALLONC

https://mdanderson.co1.qualtrics.com/jfe/form/SV_3TYiCLWRmO8RRzf

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.]

Guest Post by Liese Groot-Alberts

Liese is an experienced Palliative Care Educator, Mentor and Clinical Supervisor who has helped and inspired many people in New Zealand, Australia, the Pacific Islands and many other countries. I’ve had the pleasure of seeing Liese present live in person at various conferences and workshops, which has always been a real treat. Liese has kindly shared some of her personal thoughts in the hope that they will help others during the trying times that we all find ourselves in. Thanks Liese!

 

The art of communicating compassion in PPE: Pantomime of Purposeful Expression.

behind glass

“ behind glass” by Marta Bevacqua, Paris

 

“Make your choices based on love, not fear” – Dr. Elisabeth Kübler-Ross

In my work as a mentor and clinical supervisor of healthcare staff, I am currently hearing expressions of grief, frustration, anxiety, concerns and sometimes a sense of powerlessness in this Covid-19 pandemic. Staff are talking about feeling clumsy and inadequate in their communication of compassionate care to patients through layers of PPE. This combined with a high-powered, stressful, anxious working environment makes it paramount for staff to commit to time for self-care and self-reflection, increasing their awareness of how they are in body, mind, heart and soul, in order to be able to practice compassionate care.

I repeatedly hear: “I don’t have time for self-care or reflection, I am too busy juggling work and home, I feel like I am running all the time.”

I totally agree, life before covid-19 was busy enough and now is for most – in essential services especially- even more pressured. However, I also would like to challenge your statement of “no time” with a simple exercise to do at work, that takes about 15 seconds, can reduce some stress and anxiety and be helpful in re-connecting you with your compassion.

Unless you are on your way to an emergency of course, then just take one deep breath and run!!! Continue reading

#PalliCOVID #PallANZ tweetchat 5/5

#PalliCOVID #PallANZ 5_5

Check in with other Australians and New Zealanders involved and/or interested in palliative care during the COVID-19 pandemic during our third #PalliCOVID #PallANZ tweetchat on Tuesday 05/05/2020.

Join our special guests Rohan Greenland @PCACEO (CEO of Palliative Care Australia @Pall_Care_Aus) and Dr Richard Thurlow @Richt13Thurlow (Board Chair of Hospice New Zealand) to share your experiences and exchange resources.

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?

We hope you can join us for another great discussion!

 

I think therefore I am? – Online wellbeing resources from the NZ Mental Health Foundation

5ways

Wellbeing resources for frontline healthcare workers are available from the NZ Mental Health Foundation’s website – this easy to navigate website includes lots of useful tips for this difficult time we all find ourselves in. As well as links to websites, Frequently Asked Questions, and downloadable resources.

allright

On a similar theme is their well-designed All Right? website which also includes links to their getting through together campaign designed with COVID-19 in mind. Plenty of good wellbeing ideas for all age groups are contained in this vibrant, colourful and energetic looking website. Well done NZ Mental Health Foundation!

Both of these websites are well worth a deeper exploration and may be helpful to yourself and others in your bubbles.

Stay safe and take care.

COVID-19 Resource Links page available on our menu

Hi everyone,

We have curated/collated links to COVID-19 related palliative care resources onto a special page that can be found via our menu.

Please check it out, and please share with us any other resources you’d like added to the comments section.

Stay safe and take care.

Together we will make it through this.

James for Team Palliverse.

I think therefore I am? – If only there was an App to help us through COVID-19…

Mentemia

My 10 year old son and I watched a story about the Mentemia App on TV last night. Mentemia means ‘my mind’ in Italian.

Mentemia is a wellbeing App that has been co-developed by NZ’s Sir John Kirwan, famous former All Black and long-time Mental Health Advocate. Mentemia is currently free to download for all New Zealanders thanks to a funding deal between Mentemia and the NZ Ministry of Health. It is available on the Google Play and Apple App Stores.

We downloaded it last night and we both started using it.

It has a nice user interface and is easy to navigate, with good use of Simple English throughout. We found the interactive exercises fun to do, and things like spinning the wheel to choose a daily act of kindness to perform are also cool additions.

The ability to record how your mood is at anytime will be useful.

Lots of links to useful videos and articles to read, including lots of staying calm through COVID-19 articles.

At first glance Mentemia looks like an useful wellbeing app that we will both be returning to on a daily basis.

Some parts of the app are still a bit buggy, so far we’d give it a 7/10.

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

Accessible video about NFR (not for resuscitation) orders for patients and families

Image

Dr Barbara Hayes and Prof Joe Ibrahim have combined forces to make this elegant simple Youtube resource to explain not for resuscitation orders, cardiopulmonary resuscitation, and advance care planning for patients and families.

It works through the differing perspectives of medical teams and patients and their families to explain why sometimes CPR can do more harm than good.

Happy #advancecareplanning week!

Sonia

#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!