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Nurse Jacqueline Kells on Palliative Care

For a long time, the words palliative care struck a note of fear as meant that you or your loved one was close to death. But palliative care today is an active and total approach to care from the point of diagnosis of a life-limiting condition.

As we come to the end of Palliative Care Week, nurse Jacqueline Kells highlighted the fact that there is far more to palliative care than medication.

“The important thing for me is that it is not just about physical needs. You must cater to every aspect of a patient’s being. That means looking at spiritual and psychological approaches and knowing that it is not just about medication. For my patients, this nursing home is their home now and people must feel safe and comfortable here. We want to keep them well and help them manage their condition so they can get the best out of life,” said Jacqueline, who works in the College View Nursing Home in Cavan.

Palliative care focuses on helping a person, of any age, with any life-limiting illness, to achieve the best quality of life. It involves the management of pain and other symptoms and provides support for social, emotional and spiritual needs.

The Palliative Care Week campaign coincided with the launch of personal video stories of people who have benefitted from palliative care.

Jacqueline, who has more than 30 years’ experience, has been working with the elderly in College View Nursing Home and a large portion of her work would involve palliative care. This work has been made much more straightforward by the new Palliative Care Needs Assessment (PCNA) pocket guide. It aims to provide guidance to all health and social care professionals who provide or co-ordinate the care of people with life-limiting conditions.It helps professionals to assess the palliative care needs of patients with life-limiting conditions and to decide when it is appropriate to refer to a specialist palliative care service.

The guide was compiled by the subgroup of the Palliative Care Needs Assessment Forum Group North East.

“The majority of the residents here have some form of cognitive impairment such as Alzheimer’s, dementia or Parkinson’s. There are many chronic conditions and the pocket assessment guide has been very helpful for me. I carry it around all the time and it gives me the support I need to help address the varying conditions,” said Jacqueline.

“The guide helps me to formulate questions to ask in order to assess the palliative care needs of a patient. Palliative care used to be far more problematic but I have seen a huge transition during my 30 years as a nurse. Once, palliative care used to just be about dealing with patients dying with cancer. As soon as you started talking to a family about palliative care, they assumed their loved one would be dead within a few weeks. That isn’t the case anymore.”

She said it is very important that the utmost is done to keep residents out of hospital.

“It is not just physical problems, there are other problems linked to the adjustment for people coming to live in the nursing home. We take a holistic palliative care approach. This is now their home and they generally never want to go back into a hospital again and our aim is to meet all their physical and emotional needs to ensure that they avoid those repeated admissions to hospital,” she said.

“We provide comfort care to minimise visits to GPs or hospitals. There is no point in telling a 96-year-old woman that they need to go off to hospital to sit in A&E for 24 hours to get a simple procedure done that we can now do here,” she explained.

Jacqueline revealed training has played a major role in staff being able to deliver better services to patients. She was full of praise for the Meitheal Programme and the Specialist Palliative Care team in Cavan and Monaghan, who have been working in partnership with elderly patients on palliative care.

“As staff, we are now much better trained so are in a position to offer more services ourselves. People are living for longer and that will mean that often their condition will develop or worsen so we need to be upskilled to deal with advancing symptoms,” she said.

“We are constantly training and sharing our learning with our colleagues. You come across so many conditions and it is important that we share our experiences so others might know what to do in the same circumstances.

Improved resources are also playing a major role.

“We now have so many resources available to us which enable us to talk better to residents and their family about their needs in terms of palliative care. For example, if a resident needed to go on a pump, we have better tools available to fully explain what that will mean for them. If you can allay their fears, that makes things so much easier.

“There are so many resources now available to us online that make things a lot easier for delivering the care people need. There are also useful tools like morphine calculators. We also have prompting posters displayed all around the nursing home here to help us.

“And the pocket guide gives us a number of prompts in different scenarios that help up provide a more holistic approach to the palliative care.”

She said that help is always close at hand when you find yourself in a new and challenging position.

“We have gone through lots of training to improve our skills but when we find we need help, we have a very good Specialist Palliative Care here in Cavan and Monaghan who support us fully. Jennifer [Richardson, the CNS for the Meitheal Programme in the counties] is always at the end of the phone if we need advice or have any questions,” said Jacqueline.