Reducing patient suffering across India through Palliative Care training programme
The smiling faces and kindly manner of the nurses who looked after her when she was admitted to hospital with a fever as a child, stuck with Sheeba and inspired her to seek out a career in nursing.
After her schooling, she shared her interest with her parents and they thought it was good to help people who are suffering.
While Sheeba certainly encountered suffering during her training and found ways to alleviate it, she was not introduced to the concept of palliative care until later. After two years working as a staff nurse in a private hospital, a friend encouraged Sheeba to join the palliative care department of the regional cancer centre. Immediately, she says, she realised that this was ‘proper care’. A visit to a patient at home made a huge impression on her.
“The patient was crying out in pain and was unable to eat for a couple of days. So we administered morphine. I had not come across morphine before but immediately realised that it was a good drug for pain relief for cancer patients.”
At about this time, Sheba’s aunt became very ill with cancer.
“I didn’t know how to help her but I realised if I could learn palliative care I could help my aunt. It was a real eye-opener for me, a major turning point.”
One of the Palliative care Physicians from a RCC (Regional Cancer Centre) encouraged her to attend a Palliative Care foundation course at Amritha Institute of Medical Sciences. During the course, she got the opportunity to meet Dr. M R. Rajagopal. Inspired by him, in 2006 she started work at Pallium India (headed by Dr.M.R.Rajagopal) as a palliative care nurse.
In 2016 Sheeba was successful in becoming the training coordinator at Trivandrum Institute of Palliative Sciences which is the training wing of Pallium India Trust, and now a World Health Organisation (WHO) Collaborating Centre. Here they offer various courses in palliative care for doctors, nurses, social workers, health care workers and volunteers. Approximately 40 doctors and 40 nurses are trained each year. For volunteers they offer a 3 day-volunteer training programme which is informed by the WHO guidelines. All who attend are encouraged and taught that they are capable of implementing palliative care in their community, and are supported by Sheeba if needed. This enables Sheeba to stay connected with people from various settings. Their valuable feedback is always an energy boost for her as it reinforces the fact that she and her team are reaching more patients through the care provision of others.
What drives you to make a difference?
Whether it’s sharing knowledge and skills through training, empowering nurses to set up new palliative care centres or delivering patient care directly herself, Sheeba is equally satisfied.
“I am very happy to work in patient care but I also love teaching,” she says.
How do we see the art and science of nursing expressed?
“As a palliative care nurse we should not forget human touch and kindness and compassion. We have to see the people who are suffering, realise their suffering and take care of them and their family. If we don’t look at the emotional, social and spiritual parts, then that will increase their physical suffering. And then the whole family will be affected. We may learns things from a textbook but we must not forget about human touch and kindness.”
How can nurses strengthen their leadership and impact?
Sheeba says palliative care nurses have numerous functions to perform and that this separates them out from other nurses.
“We have many roles. We work as care givers and sometimes as an advocate as the patients can’t communicate for themselves and we need to talk on their behalf to their care givers. For total care we need to do whatever is necessary based on the situation. In palliative care, care is centred on the patient as well as the family.
In palliative care we focus more on multi-disciplinary team approach and maintaining good inter-professional relationships.In our palliative care settings each member of the multi-disciplinary team can express their view in decision making. Most of the time nurses take an initiative and do many things for patients and their family.”
New doctors starting at Pallium India quickly follow this example and learn to adapt to this way of working, with nurses taking much more of a lead.
Sheeba says: “When new doctors come they observe our relationship with other doctors, and our attitudes towards the patient, as well as the way we communicate. It makes them think how different palliative care is, and slowly get along with us.”
Having seen the potential benefits good palliative care provides patients, Sheeba has dedicated her career to disseminating the knowledge and skills to as many of her nursing colleagues as possible. She is almost as passionate about the role of the nurse in palliative care, as she is about its ability to relive pain and suffering for both the patient and their family.