Margaret O’Connor – a life dedicated to palliative care research and practice

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Professor O’Connor’s research and work in the palliative care sphere has brought care for those at the end of their lives – and those that care for them – into the forefront of healthcare worldwide.

“Retirement” meant that Professor O’Connor would cede the Vivian Bullwinkel Chair in Palliative Care Nursing at Melbourne’s Monash University School of Nursing and Midwifery – a position she held as the inaugural chair from 2003. The aptness of that position becomes clearer for non-Australians with the explanation that Vivian Bullwinkel was the sole survivor of a Japanese massacre of Australian Army Nurses imprisoned after the fall of Singapore. During their incarceration the nurses cared for colleagues who were dying from tropical diseases and malnutrition, ensuring that each had the most dignified death and burial possible in such deprived conditions.

Margaret O’Connor is a tenacious advocate for her chosen vocation. And retirement in her case is a subjective term with her newly bestowed role of Emeritus Professor of Nursing at Monash.

In her new semi-working life, Margaret has taken on a number of board positions; she has started her own consultancy and works as a research consultant and clinician at Melbourne City Mission. She is still passionate about palliative care and keen to make an ongoing contribution.

Until 2012 she was a member of the Australian Health Ethics Committee of the National Health and Medical Research Council. She served as President of Palliative Care Australia for four years from 2006. Professor O’Connor has twice been awarded the Nina Buscombe Prize by the Motor Neurone Disease Association of Victoria. She is a life member of Palliative Care Victoria and Palliative Care Nurses Australia has named an oration in her honour.

Only days “post Bullwinkel”, ehospice met her to discuss her work … where else but at the City Mission where she first worked in palliative care in the early 1980s.

Professor O’Connor came to nursing via Melbourne’s Mercy Hospital in the 1970s. Her palliative care epiphany came when she heard Katherine Kingsbury, Director of the City Mission’s Palliative Care Service speak about caring for dying people at home. Kingsbury explored service provision for the frail aged, disabled and terminally ill, winning a Churchill Fellowship in 1979 that allowed her to explore the viability of home-based services. A few years later, she would help set up Australia’s first home-based palliative care service.

That piqued O’Connor’s interest, though she admits the lack of shift work and no requirement for uniforms were additional big drawcards.

She says the opportunity to do her doctorate in nursing opened many doors and enabled her to pursue academe as part of her career. “I don’t think I would have survived working in palliative care as long as I have without the variety of roles I’ve enjoyed.”

Decades later, it’s hard to reconcile the different Margaret O’Connors. Is this practitioner, seeing clients in the austere surroundings of a converted church in inner city Fitzroy also the researcher and academic who has influenced the direction and growth of palliative care for so many years?

The breadth of her research encompasses all aspects of palliative care and addresses issues that arise with expansion and growing awareness of the sector. Her research interests centre on key areas – workforce; roles and responsibilities; decision-making; and service access issues. Projects involve clinical partners and many research questions have arisen from within the clinical setting.

O’Connor acknowledges that, despite the desire of many to die at home, changes in health care and an ageing population mean that more people are dying in acute hospital settings. The refinement of palliative care principles may have resulted in quality care for the dying, but many hospital patients die while receiving aggressive, life prolonging care.

To that end, she was recently involved in exploration of nurses’ ‘recognition of’ and ‘responsiveness to’ dying patients and understanding their influence on end of life care. Interviews with 25 nurses over 20 observation periods revealed potential impacts on patient care, including ward design, nurse allocation and nurses’ attitude to death. Interviews showed that end of life care in a single room can have negative consequences for the dying. Nurses demonstrated varying degrees of discomfort, indicating their lack of preparation for the role. The survey concluded that more work was necessary to investigate how nurses’ attitudes towards caring for dying patients in the acute hospital setting may impact on patient care.

Alongside her research interests, Margaret O’Connor has played many roles in the establishment and management of mainly community-based palliative care services in Melbourne.

“In relation to clinical care, I have an enduring philosophy that one should make the most of every day,” she says.

“Having listened to people filled with regret at the end of their life, I conclude that regret is such a wasted emotion. That has given me the impetus take on challenges and to ‘have a go’ when new opportunities arise.”

Margaret O’Connor is a big picture person. She says she has been privileged to sit on the boards of both the World Palliative Care Alliance and the Asia-Pacific Hospice Network.

“Both have given me a global view of the breadth of palliative care and an appreciation of how fortunate we are in Australia to have well-developed, well-funded services and the national advocacy and strategic voice of Palliative Care Australia.”

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