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Signs of success in palliative care
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.
“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.”