Reflections on Daw House
A blog post written by Kate Swetenham, Service Director, Southern Adelaide Palliative Services, SA Health
I was appointed as the Clinical Nurse of Daw House in September 2002. I remember my first impressions of the place. As an outsider coming from a brand new hospital I found the aesthetic to be something that required a complete overhaul, but I was greeted by an enthusiastic nurse who said to me, “I know what you are thinking, this place is amazing!”
No, that is not what I was thinking. But I can tell you that within half an hour of commencing my first shift in Daw House I witnessed something that I thought health care had lost. I witnessed holistic patient care like I had never seen before. The attention to detail and a “nothing is too much trouble” attitude was the embedded culture. Sitting amidst distress and providing silent presence was a skill I came to appreciate as did the many families who benefited from this skill. This compassion is as strong today as it was in 2002 when I first arrived.
As the service has matured over time we have recognised the need to participate in outcome measures that reflect the patient experience. We recognised that weight gain, as a result of consuming all of the chocolates grateful families left behind, may not be the most robust outcome measure and the introduction of the Palliative Care Outcomes Collaborative quality measures provided a different approach to measurement. Our patients are encouraged where possible to record the distress they experience from the symptoms that are troubling them, and our team reviews their scores and integrates this into the care plan. So, now we can place our hand on our heart and say an admission to Hospice will see, for example, pain scored between moderate and severe return to either mild or absent within 48 hours. This is an achievement to be proud of and another example of the holistic approach grounded in partnering with our patients and families.
Daw House makes up part of the clinical service that is Southern Adelaide Palliative Services. We have a community team and liaison team that support patients at home or in the acute hospital setting. The clinical work that occurs in the other settings outside of The Hospice supports our patients to meet one of their key desires which is to be at home for as long as possible. Currently we have just over 500 active clients on our program receiving varying levels of service engagement. About 250 patients are receiving home visits with the remainder being reviewed in outpatient clinics, aged care facilities or other hospitals in the south.
Southern Adelaide Palliative Services is modelled on the triple strand of care where research and education inform and enhance clinical care. Strong links with Flinders University through education and research has resulted in national and international recognition for which we are all very proud to contribute to and be associated with. Clinical Practice needs to be contemporary and evidence based. Palliative care research has as its core, the desire to enhance quality of life so that there is always something that can be done to improve or enhance comfort when curative treatment has been exhausted.
But we also know the value of the consumer voice and a consumer representative makes sure that patient experiences are acknowledged. We know they value a private room with room for an extra bed for overnight stays; ease of parking for their visitors; kitchen services that the patient’s family can access at any time; having a view out to the garden; and natural light from the window.
As we move forward to Flinders Medical Centre we will take with us the triple strand of care and the desires and values that our patients have expressed. Our clinical practice will continue to be informed by research and education, and the proximate positioning of the research and academic services to the new Hospice will enable that to continue in its development and integration. For our patients and families, there are single ensuite bedrooms with large windows facing either to the hills or the sea. The daybed will enable a significant family member to stay overnight in comfort. There will be some quarantined car parks for Hospice visitors to ensure that ease of access so appreciated at Daw House. While it is impossible to recreate the gardens that were loved at the Repat, the essence of greenery will be incorporated into the rooftop garden against a backdrop of the beautiful coastline from Marino to as far as the eye can see looking North. And most importantly we will take with us is the culture of compassion and care for people at the end of their life. Our service has a lot to offer Flinders Medical Centre and the Daw House way will be the legacy that we carry forward to be beacons of excellence in the delivery of compassionate holistic care.
Kate Swetenham, Service Director, Southern Adelaide Palliative Services, SA Health