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.

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“ 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

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

Palace of Care – In his arms

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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.”

I think therefore I am? – The D word

It was only about 80 years ago when communities all over the world were much more familiar with Death and Dying. This was before antibiotics, modern surgical techniques and lots of medical technologies had been invented. Now Death and Dying are not so obvious and it is not uncommon for 30+ year olds to have never been to a funeral before in their life.

Even now, Death and Dying are still D words that are avoided by many clinicians as they try to ‘protect’ their patients. Who are they really trying to protect? Themselves?

Other D words could be:

Denial

Disavowal

Disillusionment

Disappointment

Despair

Defeat

These were some of the D words that came to mind while listening to this podcast:

Dr Kathryn Mannix talks about her best-selling book “With the end in mind,” and reflects on her Palliative Care career

Have a listen and let me know what you think.

James

#COSA17: #PalliativeCare reflections on the 44th Clinical Oncology Society of Australia Annual Scientific Meeting

Circular Quay

Despite being a Melburnian, I must admit that Sydney really is an irresistibly beautiful city when the sun comes out, especially by the water. The 44th Clinical Oncology Society of Australia (COSA) Annual Scientific Meeting was held in the newly renovated International Convention Centre in Sydney between 12-15th November 2017. With the sunlight streaming in through its many windows, reflecting off the waters of Darling Harbour, it really was the perfect place to be at the beginning of summer.

I attended the pre-conference workshop on cancer supportive care, which was organised by Judith Lacey, a palliative medicine specialist at Chris O’Brien LIfehouse. The whole-day workshop featured an interesting mixture of passionate speakers promoting a range of complementary treatments including medicinal cannabis, massage and probiotics; alongside others examining the evidence base for acupuncture, reviewing current clinical trials and prescribing pathways, and comparing different funding models for supportive care. It was a long but worthwhile day that set the mood for the rest of the conference.  Continue reading

I think therefore I am ? – A special Totara Hospice South Auckland event this Friday.

07/12/17 – Update – Attendees please note that tomorrow morning in Auckland there will be a Railway Workers Strike meaning that road traffic will likely be much heavier than usual. We have asked attendees to arrive at 8.45am for a 9am start, please factor in the strike traffic delay when planning your travel for tomorrow morning. If you arrive early you can visit our on-site Cafe Totara for a fresh Barista-made coffee, with a range of fresh food available as well, all prepared on-site. An email update will be sent to attendees who have already registered.

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Hi everyone,

Can healing occur at the end of life?

To whom does compassion need to extend to at the end of life?

These are the type of questions that will be explored in Totara Hospice South Auckland’s education centre this Friday morning, 08 December 2017 9am to 12pm.

We are privileged to be hosting two international speakers.

Dr Rob Rutledge will be joined by a special guest.

We will be honoured to also have in attendance, Tibetan Buddhist Monk, Za Choeje Rinpoche.

zach

Please join us for a very special interactive workshop in which we will attempt to challenge your thinking and change the stasis quo.

RSVP details are contained in the below pdf.

Morning tea refreshments will be provided.

Please pass on this invitation to anyone in your networks who might be interested in attending.

Cheers,

James

Invitation Compassion and Healing Seminar.pdf

An open letter to Victorians on #PalliativeCare #VAD #euthanasia

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PC clinician open letter Final

Funeral services in Australia: Moves toward greater clarity at a time of great vulnerability

When you think about funerals, what is the first thing that comes to mind?

It may be a favourite scene from ‘Six Feet Under’ – the cult TV drama series depicting a family-run funeral home in Los Angeles. Or, it might be an iconic image of those prominent funeral companies that can seem to dominate the industry. If, however, you are currently in the throes of organising a funeral – chances are you may not really know what to think, or where to go in terms of navigating this very difficult passage of time.

As a social worker or nurse working in palliative care, you may be unsure of what resources are available to help support families’ decision making during a time of mourning. That’s where a novel funeral home comparison site can be of great assistance – you may find what you are looking for Gathered Here.

Continue reading