Hospice as a philosophy or value was first applied to a national health service by Dame Cecily Saunders who in the 1960s started a revolution in the care and treatment of the terminally ill. As a young doctor Cecily Saunders undertook to change the plight of cancer patients who were dying in hospital wards where staff were preoccupied with curative treatment. At the time of Saunders’ reform in care of the dying, cancer patients often suffered aggressive treatment almost to the point of death.
Throughout history the term hospice has been synonymous with devotion,kindness, compassion and caring, values that aligned perfectly with Cecily Saunders’ proposed model of total care for the terminally ill.
During the forty and more years since Dame Cecily first challenged the health care system to take better care of the terminally ill, the values of hospice have evolved into the science of palliation. Palliation is a useful term because while hospice defines the philosophy palliation describes the practice.
Palliative care was suggested by another hospice pioneer, Professor Balfour Mount from Canada, because the Latin and Greek meaning of palliation is to cloak or cover and some say to shield. Thus palliative care means to cloak or minimise the symptoms of advanced disease while at the same time shielding the patients and their loved ones from unnecessary harm caused by the situation.
Care and Caring
A distinguishing feature of the modern hospice movement is the alignment of palliation with care. I believe it was Balfour Mount who asserted that without ‘care’, palliation lacks distinction. Without ‘care’ palliation would be a ‘no frills’ mechanical process of symptom management and body maintenance, with no acknowledgement of the effects on the human experience and relationships.
Karuna Hospice Services by its name is declaring a commitment to compassionate care that embraces the total dimension of the human experience dealing with serious illness and the end of life. Kindness, compassion and care are fundamental qualities and care-giving an essential skill of Karuna’s staff and services.
Care and care giving is always in danger of being devalued as no more than ‘common sense’ or something that ‘just comes naturally’. While it may be an innate human quality, caring for seriously ill and vulnerable people is an art requiring complex skills. There is a science of caring as demonstrated by the numerous studies on, for example the elements of a caring relationship, the qualities of good care givers and the effects of care deprivation on infant development.
Hospice-Palliative Care in the 21st century
An important responsibility of the modern hospice-palliative care movement is to ensure that patients receive ‘evidence based’ or ‘best-practice’ clinical, psychosocial, spiritual and cultural care. This means that clients and families can be assured that the treatment or services offered are ‘tried and tested’ or proven in other ways to be the most appropriate for their situation.
Karuna Hospice Services is involved in several state and national projects that are working to improve services and meet standards of best practice. An example is Palliative Care Outcome Collaborative (PCOC) which is concerned with collecting data about practice and outcomes from which the standards of best practice can be determined.
Karuna is the lead organisation of a Commonwealth funded education project for registered nurses.The Specialist Nurse Education Project (SNEP) aims to prepare nurses as beginning level palliative care specialists. The SNEP course, which was developed with the Centre for Palliative Care Research and Education and the Royal Brisbane and Women’s Hospital, received credit worthy status in postgraduate nursing courses at QUT.
Karuna is also working with the Palliative Care Network and Brisbane South Palliative Care Collaborative to develop best-practice guidelines for the handling of medications in the community.
Evidence-based or best practice is quite rightly the mantra of 21st century hospice-palliative care. The qualities of kindness, compassion and caring that underpin Karuna Hospice Services, while more difficult to define are never-the-less subject to scrutiny. Good care should be evident by the client’s quality of life, the family’s peace of mind and the enhanced self-esteem and self-confidence of the staff and others.
It’s wonderful that Karuna provides such a quality service.
by Dr Deborah Prior RN.PhD. FRCNA, Chairperson
