CASE STUDY: Alexandra nurse helps locals plan care on their terms

In April 2018 Jeanie Hurrey opened an advance care planning clinic at Alexandra District Health in regional Victoria. As word has got about town, a steady stream of locals have visited Jeanie to help clarify and document their future healthcare preferences and make sure they receive care that reflects their values and preferences.

 “I first became aware of advance care planning after hearing a feature on ABC Radio National about supporting patients to make informed choices about their future care. This really piqued my interest and led me to gain the knowledge and skills to implement advance care planning at Alexandra District Health.”

“As an associate nurse unit manager at the Alexandra District Hospital for nearly 20 years, I’ve witnessed the emotional stress that many families face in making medical treatment decisions for loved ones when they’re not sure of their wishes and preferences."

I’ve seen a real community need for this service, particularly with the burgeoning workload of our local GPs and ageing community. This has inspired me and my colleagues to make advance care planning a priority and open the clinic.”

“Since starting the clinic and talking to people about their health and their wishes, most people’s preferences are remarkably similar – they would prefer to avoid prolonging the dying process, not have unnecessary futile treatment, and not to be in a permanent vegetative state. People mostly prefer quality of life over quantity,” Jeanie says.

Small town. Big Heart.

Jeanie says she has been fortunate to win the support and funding of the hospital management who could see the value of the clinic to the community.

Alexandra is a small community, two hours north of Melbourne, with a population of 2600. Like most country towns, locals typically say they would prefer to receive their medical treatment and care in the community rather than be transferred to a metropolitan hospital. Whilst the hospital is equipped to treat and care for most people, sometimes a patient’s illness will see them transferred to the city for specialist treatment or closer monitoring. Without a clear advance care directive (ACD) or a substitute decision-maker, patients are transferred to Melbourne. Unfortunately, some people spend their last days away from their community.

“This is not the end that many of our patients want, particularly the elderly. But if they end up unable to speak for themselves and they have not documented their wishes, this is how the story plays out,” says Jeanie.

“Recently we lost an elderly man who had been reluctant to complete an ACD, despite being very unwell for some time. He had only recently been discharged from our hospital when his condition deteriorated and he was returned to hospital. The hospital staff knew that he would not want to be transferred to Melbourne and would opt for comfort care in Alexandra but we had to let him go. There was no ACD and we could not reach his substitute decision-maker. He died in Melbourne the next day. Fortunately his family were able to be there for the end.”

“Our clinic is providing a vital service to the community. We offer the time to talk through advance care planning and help people to carefully consider their options while they are well and of sound mind, rather than making these decisions in the heat of a crisis.”

Honouring their wishes

The positive impacts of the clinic are already starting to be felt in the Alexandra community.

The hospital recently cared for a cancer patient facing end of life. The person had previously documented their wishes with Jeanie and clarified a preference to stay in the local community, being cared for by known and trusted health professionals. The treatment team at the hospital was able to honour the patient’s last wish which was to take their last breath under the stars. They wheeled the bed into the hospital gardens where family and friends gathered to share final moments. It was a small but powerful gesture, made possible by a caring and compassionate treatment team.

“It was a touching moment and really highlights the personalised care that regional hospitals like ours can provide patients,” reflects Jeanie.

It takes a village

In addition to the support of hospital management, Jeanie has been heartened to see the Alexandra healthcare community come together to support advance care planning.

“We have the local GP clinics on board with this initiative, the local ambulance crew and of course the hospital. We’re also working with residential aged care providers, educating staff, residents and their families about advance care planning. We’re all working together to ensure the people of Alexandra are informed about their options, have the opportunity to document their preferences and appoint a substitute decision-maker,” explains Jeanie.

Taking the time to listen

Jeanie’s fortnightly advance care planning clinic is frequently booked out. She reserves an hour for individuals and 1.5 hours for couples.

In a typical session she takes the time to explain the process to people, ask questions about their life and values and discuss the different medical treatments they may or may not want.

“When I speak to people about resuscitation, at first they often think they would choose this option. However when we properly delve in to it, many people change their mind, particularly if resuscitation means that they are unlikely return to full health.”

Jeanie then refers patients on to the local GP to have their documentation signed. The GP clinic then uploads it to their file and a certified copy is forwarded to the hospital.

Advance care planning for everyone

“As far as we know, ours in the only clinic of its kind in Victoria which makes all of us at Alexandra District Health incredibly proud,” says Jeanie who is looking at upskilling her colleagues to ensure the program can continue independently of her involvement.

In educating colleagues and the community about ACP, Jeanie drives home the message that ACP is not solely about end-of-life care.

“I’ll tell anyone who will listen – write an advance care directive, regardless of your age! We don’t know what lies ahead. Be prepared!”