When Sharon Butt’s elderly mother became gravely ill, she was air-lifted from the hospital in Red Deer to the intensive care unit at a Calgary hospital. A Licensed Practical Nurse (LPN) in Kindersley, Saskatchewan, Sharon knew the situation was dire. What she wasn’t expecting was the quality—and compassion—of care her mother received from the medical team. “They discussed death in a natural way,” Sharon said. “And they were there for my sister and me too, providing snacks and coffee and connecting us to local resources like the funeral home as well as offering grief counselling and spiritual counselling.” After Sharon’s mother died, Sharon thought about her own approach to palliative care at the Kindersley and District Health Centre.
“For the most part, we provided good care,” says Sharon. “But there was a general sense that we could do better. We just didn’t know how.” The close-knit medical team at the Kindersley health centre provides a range of care in its rural community—from emergency to obstetrics and palliative care. Sharon said they did a fine job of providing basic patient care but needed to improve pain management strategies and provide better support to patients through the social and spiritual elements of dying.
Before leaving Calgary, Sharon asked one of the nurses whether they had particular training to become such skillful palliative care providers. The common denominator was that most had taken Pallium’s LEAP Core training, which was offered through the health authority.
Upon her return to Kindersley, Sharon formed a committee of community members from a variety of backgrounds, including nurses, homecare workers, a nurse educator and a United Church minister. The Palliative Care Committee successfully petitioned the Kindersley Health and Wellness Foundation to provide funding to offer LEAP Core training in the community. In their proposal, the committee talked about the health care benefits of the training, but they also highlighted the value it would bring to the community through the creation of an integrated team of professionals from a variety of professions, including medicine, mental health, legal and spiritual. It would allow the small, rural community to offer the broad spectrum of services that patients and caregivers need throughout the palliative care experience. Without the generosity of the Foundation, the course would not have been a reality.
Next, the committee pitched the LEAP Core training at a physician’s meeting at the health centre. The physicians expressed sincere enthusiasm for taking the training, and the 28 Mainpro+ credits added an attractive incentive.
Open to the entire community, the LEAP Core participants ranged from physicians, nurses and care aides, as well as long-term care nurses, mental health professionals and other community members. “We had a waiting list,” says Sharon. “I don’t think we’ll have any trouble filling a second class.”
The two-day training was held in February 2019 and participant feedback was unanimously positive. “The facilitators were outstanding,” says Sharon. “They adjusted the course to match the participants’ needs.”
After the training, Sharon noticed an instant shift in attitude at work, and sees practice improvements every day. “The biggest difference was our definition of palliative care,” Sharon says. “Before we thought it meant the very last stages in a patient’s life. Now we understand that it extends from diagnosis to end of life, and bereavement.”
Physicians and nurses at the health centre are now more open with patients and they are more willing to have difficult conversations with families. Whereas before, physicians found it challenging to tell families there was nothing more they could do medically. Now they are equipped to provide effective pain management and other forms of compassionate care, as well as initiating those difficult discussions.
In her own work as a nurse, Sharon has noticed improvements. She is more knowledgeable about pain management, can support patients in making difficult decisions and is much more aware of the important role of family and caregivers.
As a member of the Palliative Care Committee, Sharon’s work extends beyond the health centre into the community. She spoke about palliative care at a community workshop, and the local media has covered the Palliative Care Committee’s work. It’s a good start but the committee wants to do more to raise awareness in the community. The next step in the committee’s campaign is to develop a comprehensive package that explains the basics of palliative care and includes a list of local resources, including lawyers and mental health professionals.
“We’re in our infancy, but we’re looking to take it much farther,” Sharon says. “We need to get people more comfortable talking about death and dying.”
The committee encourages other rural health centres that want to offer LEAP courses to include the community in the process. Medical practitioners are one key component, but community members can also contribute significant value. LEAP training ensures that all participants—regardless of their background, profession or area of expertise—understand the core principles of a palliative care approach and use a common language to discuss it. This empowers community groups like Sharon’s to be more effective and provide better, more comprehensive support to people they reach.
The Learning Essential Approaches to Palliative Care (LEAP) Core training is a two-day course for health care professionals who care for patients with life-limiting illnesses, but whose primary focus is not palliative care. Certified by the College of Family Physicians of Canada for up to 28 Mainpro+ credits, LEAP Core was developed and peer-reviewed by a volunteer, pan-Canadian team of subject matter experts who are committed to promoting the palliative care approach. Participants learn the essential skills and competencies of the palliative care approach while building strong teams and fostering collaboration among providers in different agencies who work together.