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EXTENDING COMMUNITY THROUGH COLLABORATIONCapturing the spirit of community for hospice by Denise L. Hawthorne and Nancy J. Yurkovich We are here. We will be with you in your living and your
dying ... —Dorothy Ley, pioneer of the Canadian
hospice movement
Since 1992, we have been on a remarkable journey. Along the way, we discovered that, as nurses, we have the confidence, compassion and knowledge to go beyond our level of expertise and make a difference in our community by serving as activists for hospice care. Individuals and families coping with the crisis of dying and death need hospice as an alternative to hospital and home, but it was an option our community did not have. We discovered that, through collaboration, we could capture the spirit of community to change this. This was, in essence, a journey of discovery. Our story begins with becoming aware of the distressing experiences of family and friends in our community of Richmond, British Columbia, who died in the prime of life after suffering from life-limiting illnesses. They indicated that, although they had previously believed health professionals would listen and understand their need for a gentle closure to life, this was often not the case. Their stories were compelling. Some felt hopeless because health professionals had implied that nothing more could be done. Others felt rejected when the routines, controls and schedules of those professionals apparently took precedence over providing a place of sanctuary where family, friends and caregivers could listen, comfort and support them. This made us keenly aware of the necessity to enhance the continuum of palliative care in our community. As nurses, we believed we could make a difference by establishing a community-based hospice as an alternative to hospital and home. Inspired by Cicely Saunders, founder of what is now a worldwide hospice movement, we envisioned our hospice as a sanctuary where hope would be renewed as individuals and families shared the mystery of life and death, and where, in addition to physical comfort, the environment would foster forgiveness and thanksgiving and aid in final farewells. [For more information about Saunders and the hospice movement, see article in Third Qtr. 2005 issue of Reflections on Nursing Leadership.] Our journey would span nearly 15 years. We began by asking other
members of the community if they had similar concerns. At an annual
conference held to explore community values and plan for change,
we offered a workshop titled “How would you like to die
in Richmond?” In these and other ways, we invited individuals
to share perspectives on the care their loved ones had received
when dying. We asked them what helped most, what was missing and
what would have made it easier for them and their loved one. The
concerns expressed were similar to those we had heard previously
and strengthened our resolve to rally the community behind establishment
of a hospice. We increased community awareness of the issues by informing citizens
of the challenges and difficult experiences that had been encountered
by friends and family members when caring for loved ones at end
of life. We emphasized the importance of having hospice—a
place where individuals and families are comforted and supported—as
an alternative to hospital or home. To expand the continuum of
palliative care in our community through development of a place
for hospice, we collaborated with government and community agencies.
To communicate to a broad audience the need for a hospice in Richmond,
we enlisted the help of the media and arranged for health professionals
with expertise in palliative care to participate in a televised
panel discussion. The community began to respond. The Rotary Club of Richmond, a local service group, joined us in planning development of a free-standing, community-based hospice. This provided the foundation for a hospice society that included members of the community. The Salvation Army, a nongovernmental service agency with expertise in health care services and a new focus in palliative care, also expressed interest in our proposal. Through negotiation and collaboration, we facilitated a unique
partnership between these two organizations that resulted in joint
capital fundraising activities, completion of a development plan
for the hospice, purchase of property and procurement of operational
funding from the provincial government through Vancouver Coastal
Health. One of us [Nancy] chaired an advisory council established
to ensure effective and efficient administration of the project. Many factors contributed to the success of this project: 1) our compassion for individuals and families at end of life, 2) the constant guidance and support of our mentor, 3) the provincial government’s adoption of palliative care as a regional core service, 4) the federal government’s proclamation that “quality end-of-life care is the right of every Canadian,” 5) the dedication and support of the Rotary Club of Richmond, 6) the initiative of The Salvation Army to partner with a local service club, and 7) the enduring spirit of the community. This spirit and commitment to hospice care as an integral part of our community continues, exemplified by a gift of quilts from the Textile Arts Guild of Richmond and the dedication of our hospice volunteers. There were challenges, too. Over time, the players changed and
regionalization of health care occurred. Some in the community
were hesitant to discuss dying and death. There was confusion
between the terms “palliative care” and “hospice
care.” Some wanted to maintain the status quo. Issues of
turf and jurisdiction surfaced. Reluctance to share health care
resources sometimes strained relationships. All these challenges
impacted timelines and project momentum. —Denise L. Hawthorne, RN, MA, is professor, Faculty of Health Sciences, at Douglas College in New Westminster, British Columbia, Canada. Nancy J. Yurkovich, BSN, chairs the Community Advisory Council for Rotary Hospice House in Richmond. |
