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Rock Street, San Francisco

I work as a staff nurse at the Specialist Palliative Care Cancer
Inpatient Unit. It provide high quality holistic care centred on the
needs of patients and their families. The aim is to enrich the quality
of life through the skills of an experienced and caring team.
Counselling and bereavement support service is available for patients as
well as for relatives and friends. Other services include specialist
rehabilitation team, study centre, research centre and telephone advice.
Complementary therapies such as massage, aromatherapy, reflexology and
hypnotherapy are provided by trained practitioners for patients.The
unit serves to care for patients with advance cancer, complex symptom
management of cancer, chronic end stage diseases where symptomatic
management is the only option and chronic end stage diseases. End of
life Care also plays a big role in the care services that is provide at
my work place. Patients and families use the varied facilities available
here and staff help them guide and support them throughout their
hospital stay until discharge to appropriate setting and/or death.The
team compromises of consultants, registrar, consultant anaesthetist and
junior doctors; The nursing staff, Occupational therapist,
Physiotherapist, Complementary therapist, Community/Hospital Macmillan
Nurses, Pharmacist, Porter, Volunteers, Voluntary Services Manager,
Receptionists, Domestic staff, Day Care staff, Counsellors,
Administration Manager, Medical Secretary and Admin Support
Co-ordinators. Each one of them play an important role in the
functioning of the unit with the patient being the main focus. Students
have a great opportunity to meet different team members and see how they
fit into the big picture and gain information about the care of end of
life patients.Patients are either referred from the community
through community Macmillan team or GP’s or through the hospital
Macmillan team. Most of the patients are known to the unit as they come
to the day unit on a regular basis for activities and to see their
consultant for follow up clinics. Providing End of life care to
patients who are dying or are in their last days of their life is the
most important and different thing that I am part of. We are very
different from other areas in terms of its ambiance that we provide to
patients and families. Preparing patient and family and having open
conversation about death and dying, providing emotional support to
support them. The amount of observation and its frequency are less
compared to the other wards. We use the highest number of controlled
drugs in the trust due to the complexity of pain management for cancer
patient that we care for. Palliative sedation is another area that we
specialise in and make sure that terminal agitation (agitation that
happens before patients are dying) are identified and patient is kept
comfortable and settled around this hard time in their life.The
unit welcomes nursing students from all years and assist them with
placement facilitation. There are enough mentors and associate mentors
to support students throughout their time at the unit. The allocation of
students to their mentor is done by the link nurse for mentorship at
the work place. The mentor is also informed about the arrival of the
students. Students are welcomed to come before hand to have a tour of
the placement area. Initial interview is very important and key in
identifying the expectations and needs of the student nurse. Work rota
is also discussed and agreed with the mentor in this interview so that
they can work nearly 40% of their placement time with the mentor as
expected by Nursing and Midwifery Council (NMC).Patients die in
the unit and we provide last offices with dignity and respect. Support
family and provide information to them on what happens next after the
death of their loved ones, regarding registration of death and papers
works that follow it. We are compassionate and have unique communication
skills that the students can learn while they are at the placement.Students
are vulnerable when they come to practice (Huybrecht et al 2011) and
they need to be supported and socialised into the practice area (HCPC
2014, NMC 2015). The unit makes sure that students are well supported in
their placement. There is a named mentor and associate mentor and
various others experienced staffs who support the students and make them
feel welcomed to the new placement and make them feel confident and be a
part of the team.Once the students arrives for their first day
at placement they are made welcomed by all staff members on duty and are
shown around the unit. Induction to the ward assist students to know
what learning facilities are available within the area and they are
encouraged to ask question and know more about the unit and its
functioning. The students work with the mentor and learn new skills and
develop on it. Students knowledge, skills and attitude towards practises
and patients and noted and advice is given if needed to support them.
Students are encouraged to visit other areas within the unit on insight
visit and on teaching days so they can see how the whole unit function
in a holistic manner.Work place is a challenging area as it is
different from other areas in terms of the deaths that we frequently
have here, it is emotionally draining and needs lots of support from
other members of staff to support each other and we have a good support
system at work. Most to all patients who are admitted to the ward have
Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) and all deaths
are expected. Nurses here have a unique role of verification of death of
these patients, so as in others ward, we don’t need to wait for the
doctor to do the verification of death. These with many other skills
students have a full range of skills to learn at the placement setting.

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