Palliative care an emerging speciality

When Margo Baker was in her second year of her registered nursing degree, she had an experience that changed the course of her career.

“My grandfather was in a palliative care unit and I was so impressed by the care he was given by the nursing staff,” she said.When it came time for Baker to choose a speciality in the final year of her degree she already knew what she wanted to do.

“When I was thinking of my grad year, I started to look at hospitals with a palliative care unit,” she said.

“I really enjoyed it [when it was covered in the degree] and I was touched by the care my grandfather received when he was in hospital.

“[Palliative care] is covered in general nursing training but it is not a glamorous part of nursing, it is not as highlighted or popular.”

Baker did six months of palliative care in her graduate year, which she said confirmed that palliative care was her passion.

“In the six months of my rotation in palliative care, you do draw on your general nursing care but most of the training is from more senior nurses, and on-the-job training which is the same for any nursing speciality,” Baker said.

Baker is employed as a palliative care nurse for the Olivia Newton-John Cancer Wellness and Research Centre in Victoria, a public hospital that provides world-leading treatment complemented by wellness programs, clinical trials and breakthrough research. Each year the centre holds its annual fun run, The Wellness Walk and Research Run, which this year is on Sunday, October 6, and will fund cancer research and provide access to world-leading wellness programs for patients.

“I think at the ONJ Centre, there is a focus on the person rather than what is wrong with them, and looking at the bigger picture in terms of palliative care, about what is important to the person in the time they have left,” Baker said.

“My job is about how I can, as a nurse, help support them to do the things that are important to them, so they can focus on the bigger picture.

“It makes a big difference when you get to also see and work with their loved ones, and building a rapport with the family. It can alleviate a lot of pressure for the family.

“A lot of our time is spent around educating the family, not just dealing with the patient. And at the ONJ Centre, with all our wellness programs, there is extra support so the patient and their family feels seen and heard. It’s not just about changing a dressing, or handing out medications.”

Baker says palliative care is perhaps one of the lesser known areas of nursing, and a lot of people do not understand what the specialty involves.

“Palliative care is an emerging specialty. It’s still quite young and the language around it is still not used very much,” she said.

“It is actually quite an innovative type of care and as nurses in this field we are very much influenced by research and trials around the world.

“Palliative care has a very different environment.

“The whole approach is about helping people to focus on being together and enjoying it.”

Baker says there are some challenges in palliative care nursing, firstly around helping people to understand what it is, but also helping to break the fear around the process of dying.

“We do see quite profound things in palliative care nursing on a day-to-day basis. We do need to have a perspective outside of work, because the accumulative burden of what we deal with everyday means we have to be able to look after ourselves – and that can be a challenge,” she says.

“But it is such a privilege to work with families and their loved ones in the last stage of their lives and support them through this hard time. As a society, we are quite removed from the dying process, and it is our job as nurses to alleviate that stress and fear and create a beautiful space around their loved ones.”

According to Lisa Roberts, a palliative care clinical nurse consultant in aged care and NSW Nurses and Midwives’ Association, community and hospital-based services have the highest proportion of palliative care nurses.

“Hospital services do not always have palliative care units so palliative care is also provided in hospital wards, emergency departments and intensive care units,” Roberts said.

“Usually palliative care will be provided by registered nurses in this setting, sometimes without additional training.”

Roberts said residential aged care facilities are beginning to recognise the importance of employing specialist-trained palliative care nurses and some organisations have palliative care clinical nurse consultants.

“The prevalence of nurse practitioners providing specialist palliative care is also increasing. Despite this many aged care facility staff do not have specialist training in palliative care and this may contribute to unnecessary hospital admissions,” she said.

“Another area of palliative care nursing shortage is in rural areas as identified in the National Palliative Care Strategy 2018.”

To work as a palliative care nurse requires a bachelor of nursing. To become a clinical nurse specialist requires additional qualifications such as a post-graduate certificate or diploma in palliative care, oncology or aged care. To become a clinical nurse consultant requires a master’s degree.

“To become a nurse practitioner would require an additional qualification of a master in nursing,” Roberts said.

“If a nurse wanted to become a clinical nurse educator, they would require a certificate V in training and assessment. The Australian government department of health provide opportunity for RNs to develop palliative care skills through a Program of Excellence in Palliative Care Approach program which provides workshops and placements for healthcare professionals within the palliative care space.

This article was originally published in The Sydney Morning Herald on www.smh.com.au on 25/7/19 by Keeli Cambourne.