Palliative care: a collaborative effort

Carol Johnson, RN, has been a Palliative Response Team (PRT) nurse for Victoria Hospice since 2004. “This is my dream job,” she says emphatically. “It's an incredible kind of nursing, where you get to journey along with someone at the end of their life, to guide them, to assist them. Of all the other kinds of nursing that I've done, I can't think of anything that's been so inspiring; it's character building, provides strength and meaning—it's just an amazing opportunity in life, to be with someone as they're dying.”

For Carol and the other Victoria Hospice PRT nurses, there's no such thing as a “typical day.” “We're the emergency response team that goes to help with symptom control or to assist the family. At any given time, we have over 370 people registered with Hospice, and any one of them can be involved at any time in our daily care. If someone is in a pain crisis, we go to their home, do an assessment, and do everything we can to make them comfortable. The next day, or even later the same day, we follow up to make sure the initial plan has been helpful.”

In addition to the excellent care provided by home care nurses during the day, all families registered with Victoria Hospice have a 24-hour number they can call to get support from a nurse at any time. In most cases it is a family doctor, cancer agency, or home care nurse that makes the required professional referral. “We go to a lot of homes where people didn't really understand the 24-hour service. They may have been registered with Hospice, but never called after hours. When they do, they say, 'You can come now?' and you hear the distress just fall away from their voices. In the dark of night, when everything is quiet, when everything seems so large in their lives, we can offer reassurance and help. They often say, 'I wish I had called three nights ago.'” 

“We are guests in people's homes,” she continues. “We arrive in a situation where the family knows the patient best, so we work together.” Teamed with a counsellor, PRT nurses offer support and work with patients and family caregivers to come up with care and symptom management plans that work for everyone. “Sometimes, after hours, we nurses respond on our own, so we need to be a nurse and a counsellor all in one,” Carol adds. “A new visit can be up to 4 hours long. It can take that long to get someone settled. There's often psychological support as well as physical support needed for the patient and their family, and we take the time.” 

The vital services provided by the Victoria Hospice Palliative Response Team nurses and counsellors are partially funded through community support. Every donation helps to provide access to these 24-hour support services, along with professional counselling for approximately 2500 patients and bereaved family members annually, both during the progressive stages of a life-limiting illness and following a death.

[This article was originally published in the January 2010 edition of Focus Magazine.]

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Quality palliative and end-of-life care for all: Our mission is to enhance the quality of life for those facing life-limiting illness, death and bereavement through patient and family centred care, education, research and advocacy.