The palliative care service is a highly skilled multidisciplinary team of specialist doctors, nurses, and social workers, allied health professionals and pastoral care; with support from administrative staff, volunteers, management and project staff.
The clinicians work across all health care settings-in the community, residential aged care facilities, inpatient settings, and the specialist palliative care units.
The team includes:
- Medical Specialists
- Social Work
- Pastoral Care
- Occupational Therapy
- Speech Pathology
- Music Therapy
Palliative care services in Tasmania have a number of senior medical specialists located in Hobart, Launceston and Burnie.
Our medical specialists provide specialist medical palliative care, and work in collaboration with other members of the palliative care team. They also participate in undergraduate and postgraduate health professional education, research, policy and service development.
The medical specialists also contribute to upskilling of GPs etc and provide general education in the palliative care approach.
A number of the specialists have conjoint appointments with the University of Tasmania. The conjoint appointees have contributed to a substantial increase in the Bachelor of Medicine/Surgery (MBBS) course content for end of life care, ethics and pain management. A new collaboration has been forged with the Tasmanian Health Organisation-South in Hobart, with inputs in years 3, 4 and 5 of medical training.
The palliative care nurses' role involves assessment, planning, collaborating, coordinating and providing advice regarding the management of patient's needs.
In the specialist inpatient setting nurses provide direct care; in the acute hospital setting they provide a consultancy service; in the community setting nurses offer continued support to patients through home visits, phone call assessments and referral to other services, according to need. The community based nurses also provide an out-of-hours telephone support service.
Nurses deliver continuing education to health professionals across all health settings through both structured programs such as the Australian Government funded Program of Excellence in the Palliative Care Approach (PEPA) and other courses in the palliative approach to care; and informally on a case by case basis. (Back to top)
Palliative care social workers assist patients to be active participants in their own care, to ask questions, to make decisions and to exercise choice about what is important to them as their priorities and needs for living change.
They support and counsel patients and families as they experience a range of emotions-such as fear, anger, anxiety, sadness and hope-with honesty, respect and without judgement.
Assistance provided can include specialist counselling/support in a range of areas such as adjustment to illness; changes in lifestyle; maintaining relationships with family and friends; managing feelings of anxiety; depression, loneliness, reactions to loss, setting goals and living well.
Assistance can also include:
- Access to written information and resources;
- Family mediation and support, helping families to manage differences in needs, ideas and feelings;
- Coordination and participation in case conferences, getting everybody together to talk about people's needs, concerns and wishes; and
- Advocacy, liaison and referral to other services, assisting people to access the community's support and help-ie. Centrelink, Carer's Respite. (Back to top)
Pastoral Care staff provide sensitive spiritual support, sacramental ministries, advance directive consultation and other services for patients and their family members. The Palliative Care Service respects the observance of the rituals and sacraments of differing faith traditions, and will accommodate and facilitate patient's spiritual and religious needs as fully as possible. (Back to top)
Occupational Therapy promotes well being and quality of life through occupation/activity. The primary goal of Occupational Therapy in palliative care is to enable people to participate in the activities of everyday life by:
- Education and advice to patients and carers on adapting to change, managing fatigue and conserving energy by making the physical side of their daily activities easier. This includes activities such as walking, showering, and getting into and out of bed and chairs safely.
- Arranging equipment hire or modifications to a patient's home for a safer, more easily accessible environment;
- Recommending suitable products to cater for individual pressure care requirements;
- Teaching carers and family the best ways to help patients sit and stand or move; and
- Advising patients on small aids to improve their independence in household tasks and personal care, for example a device to help them put on their socks, or wash their toes. (Back to top)
Speech Pathologists provide assessment, diagnosis, rehabilitation and support for individuals who have diseases that affect their ability to swallow or speak.
When swallowing becomes difficult, modifications can be made to reduce the risk of coughing/choking and increase comfort and enjoyment in eating and drinking.
Changes in speaking can bring about difficulties in being able to express feelings or concerns adequately, which can affect the ability to make choices. Therapy can help to improve speech or to tap into other means of communication to promote independence and improve quality of life.
Speech Pathologists may help with:
- Difficulties in understanding speech, the written word, difficulties in recalling words and constructing sentences in speech and writing (aphasia);
- Slurred speech (dysarthria);
- Voice changes (poor volume or intonation; creaky, whispery, breathy, hoarse qualities);
- Inability to communicate using speech-to use alternative means to communicate: gesture, writing, drawing or technology such as a computer or a lightwriter (keyboard with voice output);
- Difficulties managing day to day living such as paying bills or booking appointments (use of internet or e-mail);
- Habitual coughing or throat clearing;
- Coughing or choking on food or drink;
- A sensation of food sticking in the throat or oesophagus;
- Difficulty swallowing tablets;
- Discomfort when eating or drinking;
- Poor swallow function requiring a gastrostomy tube (PEG)-fadvice when oral intake in small amounts is indicated;
- Changes in oral management due to thick, thin or copious amounts of saliva.
Care is provided through education and support for individuals, their families and health professionals. (Back to top)
Physiotherapists can contribute significantly to the maintenance of physical function, independence and comfort for patients receiving palliative care, and have an important role in rehabilitation after surgery or illness.
- Assess patients to determine their level of physical functioning;
- Show how to exercise to reduce pain and stiffness, maintain strength, increase mobility and energy;
- Assist with managing fatigue and the deterioration of exercise tolerance and muscle strength in advanced illness;
- Prescribe and provide equipment to improve mobility such as wheelchairs, frames and walking sticks;
- Teach carers and family the best ways to help a patient sit and stand, or move, including the use of hoists where appropriate;
- Assist with the management of breathlessness with breath control techniques and aids;
- Provide oedema management including bandaging, advice, exercises and massage;
- Assist with pain relief techniques such as positioning the body appropriately, using hot and cold packs, and stimulating nerves.
- Provide advice to prevent problems from returning or from happening in the first place. (Back to top)
Volunteers are an invaluable part of the supportive network of palliative care.
In Tasmania palliative care volunteers are managed by the Hospice Care Association in the South and North West, and by the Palliative Care Service in the North.
The palliative care volunteers have committed to sharing their time with people who are living with a life limiting illness and their families.
The volunteer's role is to support and strengthen the ability of the person with a life limiting illness, and their family, carers and friends to live life as fully and as richly as possible.
They offer individualised support to people in a non-judgemental manner, with no religious or spiritual affiliation, to help them live as fully as possible.
Volunteers provide confidential, individualised holistic care with emotional and practical support, as part of the palliative care team.
Examples of support include:
- Short term respite;
- Transport to appointments or outings;
- Practical support in the home;
- Emotional support - listening;
- Complementary therapies; and
- Bereavement support.
Volunteers can not:
- Administer medication;
- Undertake nursing duties and personal hygiene; and/or
- Privately negotiate arrangements with clients.
Music therapy is available to patients on the J. W. Whittle Palliative Care Unit.
Music therapy is an evidence-based allied health intervention which aims to enhance the quality of life of patients and their carers and family.
A music therapy session can be very similar to a counselling session except that music is used as well as talking. It creates a safe and secure environment using music to express feelings, often in place of words which at times can express very little and sometimes seem so futile.
Music therapy can
- Reduce stress and anxiety;
- Promote relaxation;
- Reduce the perception of pain;
- Reduce the perception of breathlessness;
- Reduce depression and helplessness;
- Reduce feelings of isolation and withdrawal and stimulate creativity;
- Provide a creative opportunity to express thoughts and feelings; and
- Allow patients to assume responsibility and participation in their own treatment.
Patients do not have to be able to play music or sing to participate. (Back to top)