From rejection to foundation stone – reflections on a nursing development in Kerala

Categories: Education.

Some 20 years ago, Dr Suresh Kumar visited the UK to learn aspects of palliative medicine as a means of improving his practice in Kerala. On his return, he realised that replicating the model of care he had witnessed in an Essex hospice was never going to work, given the scale and nature of the challenge of dying in Kerala.

Twenty years on, Kerala boasts one of the most innovative and exciting models of end of life care in the world. Its hallmark is its network of 30,000 volunteers, trained to a high level to deliver high quality “total” or holistic care to people who are dying or bereaved.

As a result of the success of the model, the Institute of Palliative Medicine (IPM) – which serves as the headquarters for the Neighbourhood Network in Palliative Care – has been identified as a WHO Collaborating Centre.

Over the years the IPM, along with the Christian Medical Association of India (CMAI), has also trained many doctors to deliver palliative medicine through a fellowship programme. Arguably, what might be missing in its work to date is a similar approach for nurses.

This is a gap that is now being addressed. Plans for a new fellowship in palliative nursing are underway; its first cohort of students has been recruited and will help to shape and test the proposed programme.

This fellowship is aimed at training registered nurses, from a range of care settings, in palliative nursing skills. The fellowship provides a variety of training, placements and mentorship to the students over a one-year period.

The vision is to empower nurses to deliver better end of life care across Kerala and to build a strong network of nurses who can act as support for each other and grow as a community and as a collective agent of change.

Last week we visited the IPM to work with 15 nurses working across the palliative care network, and IPM’s director Dr Anil Paleri, to develop the details of the fellowship.

The pace at which they could work was astounding and we were bowled over by how receptive they were to new ideas about how to deliver the programme.

Over five days we considered the shape of the programme, the detail of the modules to be taught and an underpinning model of palliative nursing for Kerala. Exciting work!

Together we explored ways of exchanging knowledge and of building confidence and competence in nursing colleagues through a relatively short programme of learning.

We also had a go at reflective practice, explored the value of a person-centred approach to care and developed leadership and facilitation skills, in addition to thinking critically about the contribution of nursing to palliative and end of life care.

It was utterly enriching for us and feedback from participants suggests that they benefited too. Reciprocal learning cannot be underestimated as an experience and has contributed to what we believe will be an important development for nursing in Kerala, and perhaps even further in the future.

One of the participants described the potential contribution of such a programme as an opportunity to move nursing from the position of a “rejected stone” to one of a “foundation stone”. As such, nursing would be recognised as pivotal to the delivery of good care. We hope that will be what happens.

Our thanks are extended to the IPM for the invitation to be part of this exciting development and to our organisations for enabling us to travel and work at the IPM for a week.

We look forward to maintaining contact with the inspirational nurses we met and hope to introduce some of them to other colleagues in the UK who can join this journey of exploration and development.

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