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Signs of success in palliative care

1 Dec 2022

To be able to die in a place of your choosing is a key indicator of the success of a palliative care service. In Broken Hill the percentage is 98 per cent – which is just one reason to join the palliative care team in the town, says Clinical Nurse Consultant Kate Chesworth.

Bro­ken Hill. Pho­to cred­it: 169169/stock.adobe.com

Pal­lia­tive care is very dif­fer­ent to oth­er dis­ci­plines,” says Kate Chesworth, who worked in pal­lia­tive care in north­ern NSW for 15 years before com­ing to Bro­ken Hill two years ago.

There are nurs­ing skills you can teach to clin­i­cal staff, but for pal­lia­tive care work, there is some­thing not-so-tan­gi­ble that can’t be taught. It’s not pure­ly clin­i­cal care, it’s also spir­i­tu­al and psycho-social.

It is a con­scious career choice. I don’t think any­one leaves school and thinks they want to work with dying peo­ple. But it is a priv­i­lege to be with some­one at the end of life. Let’s face it. 100 per cent of peo­ple are going to die. At some point you will need to con­sid­er end of life mat­ters. You can’t avoid it.”

Pro­vid­ing good end of life care is a human right, says Kate, a right to die with dig­ni­ty and in a place of your choosing.

Kate puts the very strong nurs­ing lead­er­ship in Bro­ken Hill as a piv­otal fac­tor in its gold-stan­dard lev­el of care. She also sees this as a cru­cial fac­tor in the sat­is­fac­tion lev­el of the staff in Bro­ken Hill.

The Far West Local Health Dis­trict (FWL­HD), with Bro­ken Hill as the hub, is the sec­ond largest geo­graph­i­cal health dis­trict in NSW, stretch­ing from the Queens­land, South Aus­tralian and NSW cor­ner in the north, down to Went­worth in the south and across to Bal­ranald in the east. It is also a sparse­ly pop­u­lat­ed area of about 30,000 peo­ple in all, with many iso­lat­ed town­ships and large pas­toral stations.

I thought the Far West would be poor­ly resourced, but it’s the oppo­site,” says Kate.

I knew that the pal­lia­tive care team here had a very good rep­u­ta­tion, but it wasn’t until I arrived that I under­stood what a well-resourced team it is, led by an amaz­ing Direc­tor… We’d love expe­ri­enced pal­lia­tive care nurs­es to con­sid­er com­ing to Bro­ken Hill and give it a go because the learn­ing oppor­tu­ni­ties, and oppor­tu­ni­ties for pro­gres­sion are quite incredible.

Peo­ple are encour­aged to step up to do high­er roles, and are sup­port­ed. I think it’s part­ly because there is not a mul­ti­tude of peo­ple avail­able, with a small­er pool vying for the positions.”

Work­ing in a region­al or rur­al sit­u­a­tion like Bro­ken Hill also encour­ages nurs­es to be more cre­ative, to do more with less, Kate believes.

That has lent itself to being more invest­ed in prob­lem solv­ing,” she says.

We see a lot more com­plex­i­ty in rur­al sit­u­a­tions than in high­er-den­si­ty loca­tions, work­ing with com­plex social sit­u­a­tions, with peo­ple in remote areas on sta­tions, and with the Roy­al Fly­ing Doc­tor Service.”

The pal­lia­tive care ser­vice based in Bro­ken Hill was start­ed 34 years ago by one nurse, Melis­sa Cum­ming, who came here as a sole pal­lia­tive care nurse. She fell in love with the place, is still here, and is now Direc­tor of Spe­cial­ist Pal­lia­tive Care and Can­cer Ser­vices. There are two Spe­cial­ist Pal­lia­tive Care Ser­vices in FWL­HD, Bro­ken Hill and Buron­ga. The teams have grown over the years and ser­vices are now pro­vid­ed by a large mul­ti­dis­ci­pli­nary team includ­ing Nurs­es, Doc­tors, a Dieti­cian, Occu­pa­tion­al Ther­a­pist, Physio, Abo­rig­i­nal Health Work­er, Social Work­er, Vol­un­teer Man­ag­er and Vol­un­teers, and Bereave­ment Coun­sel­lor. The team sup­ports patients across all care set­tings includ­ing those in the com­mu­ni­ty, in hos­pi­tal and in aged care facilities.

Melis­sa was the one I spoke to when I rang up to find out about this job,” says Kate. She gave me the con­fi­dence to come out here, and now I want to pass on the word.

Here, we are guid­ed by what the per­son in pal­lia­tive care wants, not what we want for them.

Most peo­ple only know about death through pop­u­lar cul­ture and don’t real­ly know or have a good idea of what it looks like, what is nor­mal, and it’s impor­tant to nor­malise it. It is a very reward­ing career.

Some­thing I heard about sacred awe’ real­ly res­onates with me, being there at the end of someone’s life, being able to pro­vide that ser­vice in such an unlike­ly sit­u­a­tion, is incred­i­bly rewarding.”

Evi­dence shows that when the bereaved peo­ple and their fam­i­lies per­ceive an excel­lent lev­el of care they deal much bet­ter with death, Kate points out.

Our gold stan­dard of 98 per cent is unheard of. It speaks for itself.”