As the year comes to an end many of us turn our thoughts to the future. But how does it feel for the nurses who oversee transitions for patients whose time is genuinely running out?
With the impending opening of a hospice for young adults and teenagers in 2023, which we will detail in the coming week, we thought it would be worth a visit to the region’s existing palliative facility for the general population: the Northern Beaches Palliative Care Unit and the Geriatric Evaluation and Management Unit in Mona Vale.
Manly Observer reporter Alec Smart met the team from Mona Vale and spoke to Kyla Smith, Director of Nursing, and Lisa Archibald, Nurse Unit Manager about the complicated and often emotionally challenging work they undertake.
Tell us about the Mona Vale premises and what does running it entail?
“We have 20 beds in total,” Lisa explains.
“The palliative care can be end-of-life care, or it can be people coming in for symptom management and then going home. So, it’s not all end-of-life,” she explained.
“We probably have 50% of people coming in for end-of-life care and probably 50% to manage their symptoms, to aim to go home again and then, perhaps, come back in again to the unit as they need to.
“And on the geriatric side,” she continued, “there’s people coming in to be assessed, have a full allied health input, with the aim of returning home, with services, and regain their independence to remain in their home.
“It’s a good balance that we have in this unit.”
The unit in Mona Vale, opened two years ago on 7 February 2020, is located amidst the health precinct of the Mona Vale Hospital site.
“A 24/7 Urgent Care Centre, treating patients with minor injury and illnesses and a large community health centre are also part of the services provided, while the new 20 bed Palliative Care and Geriatric Evaluation and Management unit (GEM) provides inpatient palliative care and early assessment and treatment for people experiencing health conditions associated with aging.”
This reporter worked awhile in palliative care hospitals in England as a chef. Most of the patients there had types of dementia, including Alzheimer’s. Is it wrong to assume that the geriatric care in Mona Vale is geared towards dementia?
“Some of our patients do have a form of dementia,” Lisa confirmed, “but not all of them. A lot of them have mobility issues, so they might have a Parkinson’s disease diagnosis and need assistance with walking aids, medications, pain management, etc.
“If it is dementia, it’s usually the early stages of their dementia, because we’re aiming to get them back home.”
Palliative care is care that helps people live their life as fully and as comfortably as possible when living with a life-limiting or terminal illness.
When it comes to the palliative care, is it emotionally challenging to cope with, knowing that your patients, with whom you develop a relationship, might not live much longer?
“It is challenging,” Lisa agreed, “but it’s also very rewarding because we’re primarily set up for palliative care… We have an expert team and we have all the supports in place to support patients and their families, and then, obviously, for our staff.
“For me, if it means choosing to work in an area where I feel supported, I couldn’t think of a more supportive environment.”
Yes of course, as you say, the care extends to include the families, not just the patients.
“Very much the families,” Lisa affirmed. “The families are so much a part of the patient’s journey. We depend on families for support and we, in turn, support the families – it’s sort of a two way street. And patients are also allowed to bring their dogs in. They’re very much a part of the patients’ care as well.”
Staff support programs
However, the care work must come with emotional challenges. Imagine, for example, developing a rapport with a patient receiving treatment, whose company you enjoy, and then one day you go into their room and they’re no longer there.
Kyla addressed the issue of how the unit’s management assist members of the team in dealing with the personal impact of supervising patients with terminal illnesses.
“I think one of the challenges is making sure that we’re keeping on top of the staff well-being,” Kyla revealed. “So, we have a lot of programmes that we run in the unit to try and help keep the staff motivated and in a healthy mental state…
“We have clinical supervision that we provide to the staff once a month, where they can come and just have a conversation basically around how something has effected them. Strategies can be discussed about what they can do. Staff are allowed outside on their breaks, they can go down to the beach if they want to.
“They hold a discussion at the journey’s end now: if somebody has passed away, staff can have a conversation to remember that person and talk with their peers.
“We’re doing a lot of things around keeping the staff mentally healthy, because the unit has a significant number of people that do pass away, and it does take a toll. We’ve got a lot of young staff as well, so we’re trying to support them through those processes, by making sure that they don’t take on too much of the burden.”
“I think one of our biggest challenges is to prevent that burnout feeling among our staff. So we try and implement a lot of things, we try and engage the staff, we survey them just to see where they’re at…
“The staff have done an amazing job with some of the things they’ve done for mental health,” Kyla added. “We care for all ages, so we might have a bit of a run with quite young patients, like 8-to-15-year-olds, that are dying – young kids.”
Editor’s note: The younger patients who have life limiting conditions or are terminally ill are precisely those who will be serviced by the new palliative care facility in Manly. That’s set up and will be ready to take patients in the next month.
“They might be a similar age to you, have a similar background, and not only is that challenging mentally for the nurse, there are the doctors and whomever else is looking after the patients, like the support staff, who are also affected.
“So we’ve got to make sure that we look after that – check in on the staff to make sure they’re okay. Our staff manage those patients extremely well. Yes, they build a rapport, but we know that’s because they care so greatly for the patients.”
“I think the families feel relief when they come here,” Lisa added. “They feel so much support, I think they’re grateful for the care. But Kyla is right, for me the biggest challenge is supporting staff, definitely.”
Northern Beaches Palliative Care Unit website