Our healthcare site visit today was to Auckland's Starship Children's Hospital, the only children's hospital in all of New Zealand. As a result, the hospital does not turn anyone away, meaning at times they can be at 110% capacity. This statistic alone demands respect because it shows the hospital is bound and determined to do all it can to provide care to all the children who need it. It would be much easier to turn people away, but the staff is dedicated to helping every child they can possibly can, and that is awesome.
Due to a slight emergency involving our host, our order of events started backwards and we began our session with a question and answer period with Karyn, a Nurse Practitioner (NP) specializing in Palliative Care. Kayrn has only been an NP for about a year now; while the role of the NP is still relatively new and a bit uncertain in New Zealand, Karyn's views and practices on palliative care are clearly established and in use. Her perspective is "What can we do for you?" and she focuses on providing care for the family as well as for her patients. One example of this is the DNR (Do Not Resuscitate) order. Instead of calling it a "DNR", they ask the family to come up with a plan and ask them what their wishes are for the care of their loved one. I love that. A DNR is so impersonal and stiff; it is unsympathetic towards the needs of a grieving family. In asking the family and patient what they want and what their expectations are, it allows them to feel more connected and involved. It is much warmer, so to speak, and I would imagine more comforting to the families as well.
Once we began our tour, I thought a lot about what Karyn said about palliative care, especially because we toured the NICU and oncology floors in detail. On the oncology floor specifically, I found myself getting very emotional when we would pass by the patients' rooms. The children were so sweet, and it broke my heart to see heads shaven, NG tubes and IVs; cancer has made them grow up way sooner than they should have and it’s not fair.
In these situations, palliative care is a real priority and it was very apparent there is huge family involvement when it comes to the kids’ treatment. There was also a great emphasis on family comfort and helping them to feel at home, such as the kitchen where they could make and store their food. Since they do spend so much time in the hospital, providing a sense of normalcy is so important, and I was glad to see the hospital provided that.
The idea and practice of palliative care is actually present in the US, and although we don’t really have a specific term for it, at least that I know of, family involvement is a component of patient care as well. More and more institutions are incorporating a holistic approach when caring for their clients and that involves caring for the family as well. In fact, I myself have used family-centered care in my clinical experiences. I have also incorporated Karyn’s idea of palliative care as well by making sure the patients know they have choices and allowing them to decide. In every interaction I see to the comfort of the individual and ask each person what I can do for them.
When it comes down to it, palliative care is really a part of all patient care in the sense we want our patients to be comfortable and pain free, and this experience at Starship has really reiterated that for me. I honestly don’t think my professional practice will change that much because in the short time I have worked with patients I try and involve the family, and obviously tend to the patient’s individual needs as well. But, there is always room to get better, and that means more practice; good thing I’ve got a lot of years of nursing ahead of me to work on it.
Course Outcomes: 1, 2, 3, 4, 5, 9, 10 11