End of life care can be poignant and, yes, beautiful

12 May 2021

Registered Nurse Linda Dunbar vividly recalls her strong mix of emotions shortly after graduation.

“The realisation when you walk out on to the ward for the first time knowing that you are now fully accountable for patient care and outcomes brought feelings of exhilaration and anxiousness along with a sense of achievement,’’ she says.

“I was fortunate to have supportive, experienced RNs that were approachable and made you feel part of team.’’

On International Nurses Day today (May 12) - the day nursing pioneer Florence Nightingale was born back in 1820 - we celebrate the achievements of nurses everywhere.

The theme for 2021 is Nurses: A Voice to Lead - A vision for future healthcare. In 2021, the International Council of Nurses seeks to show how nursing will look into the future as well how the profession will transform the next stage of health care.

International Council of Nurses’ CEO Howard Catton says the pandemic had exposed the weaknesses in many of the world’s health systems, the enormous pressure nurses are working under but also shone the light on their incredible commitment and courage.

Now a worksite rep at the South Coast District Hospital, Ms Dunbar’s work as a palliative care nurse has empowered her with a philosophy to “live each day, life is short and fragile. There isn’t time to sweat the small stuff. Spend time with those that are important to you, don’t miss an opportunity to tell them you love them’’.

She first entered the care profession in her mid-30s, having previously worked in the family’s hairdressing business. “The birth of our third child was perhaps the impetus for considering nursing. With three children under the age of five years I felt the need to do something for my own wellbeing,’’ Ms Dunbar says.

“I had really enjoyed the anatomy and physiology units of previous study and this led to a quest for further knowledge in human health. Hairdressing may seem unrelated, however hairdressers develop really good listening skills as pseudo-therapists providing a non-judgmental space for people to unburden the stresses of life.’’

Ms Dunbar enrolled as a mature-age student at TAFE for a Certificate III in Aged Care, then worked as a care worker in aged care before deciding to return to TAFE for a Certificate IV in Enrolled Nursing. “It was here that I was encouraged by a tutor to consider going to university to do a Bachelor of Nursing. I attended Flinders University, graduating in 2006,’’ she says.

A resident of Victor Harbor, Ms Dunbar was thankful to be offered a permanent contract with the South Coast District Hospital.

“It was important to work in the community where our family lived,’’ she says. “After working for some years across the general hospital which provided general medical, orthopaedic, gynaecological, palliative care and maternity services and A&E, I was given the opportunity to work with the Palliative Care Team which provided services within the community, RACF and the hospital.

“It was during this time that I realised this was the nursing discipline that I really felt passionate about. Being able to provide care to patients in their own home, a far less medicalised environment provides familiar surroundings which can be comforting after often frequent episodes of hospitalisation.

“Supporting families to care for their loved ones and seeing how people without any nursing experience are so willing to give care is amazing. I decided to complete a Graduate Certificate in Palliative Care and later returned to university to complete a Master of Nursing - Nurse Practitioner (Palliative Care), achieving endorsement in 2017.

“Being an NP has enabled the provision of advanced nursing practice including prescribing of medications in regional areas where palliative care consultants do not currently provide a clinic and GPs do not always home visit.

“As an NP I am not a substitute GP, however the extended practice role allows collaboration with the health consumers’ GP to ensure continuity of care including initiation or changing of medications. Many of the local GPs have been very supportive of the NP role.’’

Ms Dunbar says palliative care nurses provide care and support to individuals diagnosed with a life-limiting illness and their families.  Care is provided throughout the disease trajectory from diagnosis to end-of-life care. Care may be provided over various settings including home, acute hospitals, RACF and hospice.

It is also about providing excellent physical assessment, while considering the spiritual, cultural and psychosocial aspects of care with a holistic approach.

“Palliative care is perceived as care of the dying, however palliative care nurses support people to live as well as possible with a focus on quality of life within the context of a life-limiting illness,’’ Ms Dunbar says.

“Palliative care nurses often broach and facilitate advance care planning discussions. These at time can be difficult conversations that have not been raised previously, however they are important in ensuring an individual’s wishes regarding death, dying, care and much more are known and met with dignity.’’
Palliative care nurses, she says, need the capacity to be compassionate, empathetic, good problem solvers, flexible, work well in a team environment and adaptable to many different situations particularly in the community setting.

“The capacity to listen to people’s stories or just be in a space with someone without having to fill the space with conversation,’’ she adds. “The intuition to know when it’s the right time to have difficult conversations in relation to death and dying. Capacity to work autonomously. A good sense of humour with a good measure of resilience are essential.

“It’s also about supporting, empowering and advocating for individuals and families to achieve the goals of care that they desire, in particular enabling people to die in their place of choice. I’m particularly passionate in facilitating end-of-life care at home if it’s the person’s wish.

“When a person is able to die in their place of choice with loved ones around them, the intimate conversations, laughter and times spent together that people share at this time can be very poignant and, yes, beautiful.

“When the person dies and they are no longer suffering, their face has an appearance of peace, as though all the worry and stress is relieved. Personally, I find this comforting when considering my own mortality.’’

On the topic of Voluntary Assisted Dying, Ms Dunbar believes VAD is a very personal choice, “however it is important that there is access to adequately funded palliative care services, ensuring that there is choice”.

She admits caring for the dying has “an emotional toll and I’m glad of that as it means I have not become desensitised to the suffering of others.  It is important to have regular sessions to debrief with supportive trusted colleagues and to take the time for self- care.

“Life as we know it can change in an instant, take time to enjoy the simple things as these are often the most important. I am thankful for the experiences that being a palliative care nurse has provided through being part of people’s lives if only for a short time.’’