Written by APHN Editorial Team (Malaysia) – Dr Caryn Khoo, MD
In August 2015, the palliative care community in Malaysia celebrated the graduation of the inaugural batch of students completing the Advanced Diploma in Palliative Care program. This one-year full-time training program, organized by the Malaysian Ministry of Health, was developed as an avenue for interested nurses, physiotherapists and occupational therapists to gain further knowledge and skills in palliative care, in tandem with overall efforts to expand the field of palliative medicine in Malaysia. Staff nurse Nur Anis Kashmira is among this group of 17 students, consisting of 9 nurses, 4 physiotherapists and 4 occupational therapists that made history as the first graduating class since plans for the program was first mooted in 2005. Anis shares her experience in the following interview.
Anis, you were already working in a palliative care unit before you joined this program. How would you describe your experience then?
I was first transferred to Hospital Selayang in March 2013 and was assigned to work in the palliative care unit. Back then, I had no idea what palliative care meant, and my first thoughts were that it was waste of resources to have such a unit in the hospital. I did not enjoy the work, and felt very uncomfortable watching patients die. I didn’t like coming to work, facing terminal patients, their family members and having to deal with all the emotional issues that come up. I actually requested to transfer to another department but my request was denied. After a while, I learnt to just go with the flow without understanding why we did what we did.
It sounds like you did not enjoy working in the palliative care unit back then. What made you apply for this program?
I think it was the awareness that I was lacking certain soft skills, and the desire to equip myself in this regard, especially when it comes to good communication skills and handling difficult situations with patients and families. I remember how frustrating it was when a patient’s wife complained that I was talking behind her back, and assumed that I didn’t want him around, when in reality, I was just doing my regular pass-over report during shift changes. So when I heard about this new palliative care training course, I decided to apply, hoping that I would be able to learn something from it.
It must have been challenging, uprooting and becoming a full-time student again. What was your experience like during this one-year program?
I certainly had mixed feelings about it. I was excited and eager to learn new things. However, I was also nervous about being away from my two young children five days a week; my youngest was only 3 months old at that time. Thankfully, my husband has been very understanding, and reassured me that he was more than capable of handling the kids.
We found out that this was the first time the program was being run and I was proud to be part of this first group of students. There were only 17 of us for this intake. The best part of it was that we had different working backgrounds. Some were nurses like me, others were physiotherapists and occupational therapists, and we came from different parts of Malaysia.
How is the program structured, and what were some learning topics?
The program is made up of 2 semesters, each lasting 6 months. In Semester 1, we learnt about the fundamentals of palliative care, health assessment, disease processes, symptom management and also basic statistics and clinical audits. We even had to complete a research project before graduating! Learning the theory behind opioid dose calculations and conversions as well as the use of other medications for crisis management helped me gain understanding and confidence as a nurse working in a palliative care unit. We also had the opportunity to spend some time in the inpatient palliative care wards as well as community hospices as part of our clinical postings. It was great having the opportunity to learn directly from the many palliative specialists involved.
In Semester 2, we were taught about psychosocial care and therapeutic communication. We were also then divided into role-specific modules, which were either advanced symptom management (for nurses), physiotherapy in palliative care or occupational therapy in palliative care. I really enjoyed Semester 2 especially the communication skills training, which incorporated role-plays of difficult scenarios.
Would you recommend this course to others?
Absolutely! I think each one of us has benefitted from this program. It has been a very positive experience, and we have gained significant knowledge and skills. I think this has also given me more confidence in dealing with my patients. Even though it was difficult to be away from my family during the week, what I have gained is well worth the sacrifice.
What do you think was the best part of the program?
The best part, for me, was learning good communication skills. I feel that I am a more effective nurse because of it, and happier too.
After completing this program, does it feel different to be back in the palliative care unit at Hospital Selayang? How has this program changed you as a nurse?
In contrast to my previous views, I now feel very fortunate to be working in this field, having the opportunity to help patients in their final life journey. There is so much meaning in what we do. It is true; do not judge a book by its cover. I aim to apply and practice what I have learnt throughout this program.
I am now more comfortable and proactive in my interactions with patients, exploring their concerns and expectations, and actively listening. I think I am better able to provide an empathic presence after learning this from the palliative specialists.
Any final thoughts you would like to add?
Palliative care has taught me the real meaning of “quality of life”. It is an honour to be able to accompany patients during their final phases of life, an opportunity that sometimes even family members lack. Perhaps one day, our society will realize the importance of palliative care. I just want to end by saying that I am proud to be a palliative care nurse!