B E Y O N D | J A N . T O M A R . 2 0 2 2 | I S S U E 2 7The COVID-19 pandemic is impacting many essentialhealthcare services including palliative care which is amedical and health services that aims to improve the lifequality of patients who are suffering from advanceddiseases. In this article, Dr. Hajah Asmah, an AssistantProfessor in Nursing who has a special interest inpalliative care shared with us how the palliative careteam at the Raja Isteri Pengiran Anak Saleha (RIPAS)Hospital maintains the fluidity of their services while stillcomplying with the strict public health regulations set bythe Ministry of Health (MOH), Brunei Darussalam.Palliative care services in Brunei are offered both in thehospital and community care settings. Palliative care isoffered at hospital wards to admitted patients who areunable to manage their symptoms at home. Those who arewell enough and are living at home are supported throughregular follow up appointments at palliative care clinics.For those who are not well enough to travel to thehospital, they would receive regular home visits from thepalliative care and homebased nurses. During the surge of the COVID-19 pandemic, unwellpalliative patients who have to come to the hospital forsupport are strictly triaged for the necessity of their wardadmissions. This often leaves the palliative care team in a9I H S A S S I S T A N T P R O F E S S O R D I S C U S S E ST H E C H A L L E N G E S O F P A L L I A T I V E C A R ED U R I N G T H E C O V I D - 1 9 P A N D E M I CDr. Hajah Asmah Haji Husaini (Assistant Professor)Dr. Hajah Asmah and co-author Dr. Zulkhairi Mohamadadvocate for the importance of palliative care for criticallyill patients in Brunei in an article published in biG (BorneoInsider's Guide) magazine, Issue Jan/March 2022, page 10-13. Please scan the QR code to read the article. dilemma as they would prefer the patients to be managed at home to reduce unnecessary exposure toCOVID-19. For others, patients and families are supported with regular video calls or home visits which arestrategically managed by the palliative care nurses. However, a bigger challenge posed by the COVID-19pandemic is on palliative care services for patients requiring ward admissions. Although there has been adesignated ward for palliative care services in RIPAS hospital, admission is often not an ideal option due tothe strict public health protocols implemented by the MOH for the management of patients in hospitalsettings that prevent cross-infection within the hospital ground itself. Therefore, one of the strategies toreduce potential COVID-19 cross-infection between community and hospital settings is to mix and dividehealthcare workers from various medical specialties into two teams: the ‘Dirty team’ and the ‘Clean team’. The ‘Dirty team’ focuses on the care of admitted patients in wards who are managed under their care. The‘Clean team’ attends patients within the community and functions as a ‘stand-by’ team in case the ‘Dirty team’is compromised by COVID-19. These measures therefore help to minimise movements and risk of close socialcontacts between healthcare professionals and COVID-19-infected patients. Inevitably, this team division alsomeans that the palliative care team are supporting both palliative and non-palliative patients in the hospital,and that the palliative patients may also be managed by non-palliative care specialists. To overcome thesegaps in care and treatment, the palliative care team has embraced telehealth technology which organisesregular teleconferencing with medical teams of other specialties who manage palliative patients in theirwards. Another significant impact from the pandemic was on personal communication with patients and families. Noamount of technology can replace the value of human engagement when discussing with patients and theirfamilies about their diagnosis, expected health trajectory, treatment plan, and end-of-life matters. Palliativecare practitioners are concerned that empathic communication cannot be achieved through this telehealthapproach because it limits the expression of appropriate body languages or facial expression. These gesturesare undoubtedly important for the expression of support and understanding to both the patients and families.Nonetheless, these adaptations need to be carried out to ensure the continuity of palliative care for patientsso that they can receive health support at every stage of their illness journey. Following this experience, theteam foresees the utilisation of technology in palliative care as the 'new norm' in the near future which willallow avenues for exploration in palliative communication during these unprecedented times.
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