'You only die once - we need to get it right': a palliative care clinical nurse consultant’s perspective on partnering with a residential aged care facility
A blog post written by Kathleen Wurth, Palliative Care Clinical Nurse Consultant, Port Kembla Palliative Care Service
My workplace, Port Kembla Palliative Care Service, supported a formal partnership with our local residential aged care facility (RACF) through ELDAC last year. I have always worked in palliative care, including with some of the best aged care nurses in the Illawarra region over the past five years, and my work covers 30 RACFs and almost 3,000 residents, so I knew there was room for improvement in our area. ELDAC helped us as a specialist palliative care service (SPCS) to develop a partnership with Multicultural Aged Care Illawarra (MACI), a RACF in our local area, and we saw this partnership as a great chance to collaborate and focus our efforts to improve end of life care for the residents.
One of the first things MACI did with ELDAC was identifying their gaps and areas of improvement. MACI is a unique place with the facility site in sections with new and old areas. The relationships are the heart of the place. However, traditionally we would transfer patients from MACI to the SPCS palliative care ward because there were no registered nurses (RNs) after hours at the facility and staff struggled to manage symptoms and pain with limited resources.
Despite the challenges and obstacles (including competing priorities and workload), MACI’s management was completely supportive of creating a partnership with our SPCS. After the investment with ELDAC and MACI, there was increased awareness around recognising dying, having critical conversations, advance care planning, and responding to symptoms.
Caron Roach, a registered nurse, continued with the partnership program whilst juggling a huge clinical workload. She led the teams through the auditing process and tapped into the positive energy of the care staff. Caron had a knack of working with the staff’s strengths – she knew the care staff knew their residents really well and had insight into their care needs. She helped the care staff to take the ELDAC Care Model and make it their own, with the resident at the centre of the discussion.
The care staff at MACI were up for the challenge – they became leaders, teachers, and mentors to each other and demonstrated compassionate advocacy for their residents. They built confident interpersonal skills and included the family in their discussions, often supporting families during the resident’s deterioration and terminal phase. Staff told me it was really rewarding to be able to see their residents through this last stage of life, as they were able to provide a respectful end of life experience that was aligned to the wishes of the resident to stay at MACI and be supported by the staff who knew them and loved them.
Personally and professionally this partnership between Port Kembla Palliative Care Service and MACI has been a highlight of my career, matching passion with practice. To work shoulder to shoulder with RACF staff and see the positive outcomes of the ELDAC and MACI partnership has been worth the time and investment. Recently one of the care staff told me earnestly, ‘You only die once – we need to get it right.’
ELDAC has supported staff by providing support and linkages. This ELDAC partnership translated directly into improving the dying experience for the resident, family, and staff, and this will serve the MACI residents in the best possible way. It has been about building workforce capacity, improving systems and being authentic in caring for the dying.
It’s been a year in the making, but these days I walk into the facility and am welcomed warmly by name. I feel the staff provide all the clinical information and their own ‘knowing’ of the resident. The assessments are thorough and carefully considered. Staff have anticipated the resident’s needs and had timely conversations with key people such as the GP and Person Responsible. There is a high standard of documentation and clear ways of working together.
MACI has provided our service with site maps and clarified processes for accessing resident’s notes and medications after hours. The quality and quantity of advance care plans has increased and we have not had to transfer patients out of MACI for terminal care. The palliative care champions group of care staff is self-sustaining and is a valued element of the aged care team. We have delivered Reverse PEPA sessions and the skills and knowledge of the care staff was impressive. Equipment, comfort trolleys, and family brochures are all initiatives to enhance the palliative care approach. We have participated in GP and pharmacy engagement and utilised film nights, panels, and death cafes to promote conversations around goals of care.
I am confident the staff at MACI provide impeccable assessments and respond to the needs of the family in sensitive and compassionate ways. MACI has also become a reference and resource for our area for end-of-life care in RACFs. I am grateful to the courage and vision of the MACI team to ‘walk the talk’ and make real and sustainable change for end-of-life care.
Kathleen Wurth, Palliative Care Clinical Nurse Consultant at Port Kembla Palliative Care Service
This blog is part of a series of blogs commissioned by ELDAC to support aged care health professionals and care providers in providing end-of-life care. You can find more information on the ELDAC website.