Following the publication of the report “Palliative Care – Celebrating Nurses Contributions”, each week we are profiling the contributions of a different nurse. This week, you can meet Dr Jo Hockley, from the UK.
Jo has worked in palliative care for over 30 years and had the privilege of working with Dame Cicely Saunders at St Christopher’s Hospice. Her passion has been to disseminate palliative care knowledge within generalist settings. She set up two hospital-based palliative care teams (St Bartholomew’s Hospital, London and Western General Hospital, Edinburgh) and following her PhD she has worked for the past 15 years in care homes undertaking various research and quality improvement initiatives. She currently works at the University of Edinburgh leading the work to establish a Teaching/ Research-active Care Homes (ToRCHs) Centre for excellence and community engagement to support training and quality improvement initiatives/research in care homes across South East Scotland. She has been recognised in many different forums for the groundbreaking work that she has been doing and was awarded an OBE for services to palliative nursing in 2013.
In 2008 Jo took up a job at St Christopher’s. This time to set-up a Care Home Project Team (CHPT). Eventually, as a nurse consultant, she led a team of five palliative care clinical nurse specialists (CNSs). The first five years she was there were one of the most enjoyable periods of her career – the team was extremely effective and hard-working. Staff in care homes were caring for increasingly frail older people – they did not have cancer but had advanced, progressive, incurable diseases (dementia, heart failure, stroke etc) and so the focus was on palliative care and quality of life.
As part of the project, they implemented a palliative care framework called ‘The Gold Standards Framework’ (GSF Care Homes) and at the end of five years they had implemented the framework and set up a sustainability initiative across 71 Nursing Care Homes (NCHs). Prior to the implementation, they had collected information regarding advance care planning, do-not-attempt cardiopulmonary resuscitation, and the number of residents who managed to die in their place of choice.
Before commencing the project only 56% of residents died in the NCHs and by 2013, 78% of residents had died in the 71 NCHs thus avoiding admission to hospital for the last week or so of life.
The vision for the ToRCHs Centre in Edinburgh is to have a centre that not only exemplifies excellence and community engagement for frail older people with multiple co-morbidities, but can also be the sustainability initiative that is lacking behind so many quality improvement initiatives. Jo hopes that such a vision can lead the way for excellence in the palliative care for frail older people living and dying with dementia and other co-morbidities in care homes.
Jo has learnt many things during her career. One thing is that she realised we must not impose a model of specialist palliative care, that has been modelled for people dying from advanced cancer in mid-life, onto frail older people dying at the end of their lives from multiple co-morbidities in care homes. She says that she was as guilty of that as anyone when she first went into NCHs 18 years ago. Staff in care homes taught her so much. Specialist palliative care must work hand-in-hand with geriatricians and care home staff to develop appropriate models of care for frail older people dying of very old age at the end-of-life. Another thing that she has learned is perseverance. We need perseverance if we are going to be able to navigate the often-turbulent seas that innovation has to navigate.
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