Palliative and hospice care is an approach that improves the quality of life of patients and their families
Along with experience and life achievements, advanced age brings a number of age-related problems and serious illnesses. In response to this everyday reality, modern medicine offers hospice and palliative care. This is a relatively new specialization: in 2006, hospice and palliative medicine was officially recognized by the American Board of Medical Specialties.
TREATMENT AND CARE. Head of the Palliative and Hospice Care Department Iryna Tsymbal works together with colleagues to improve the quality of life of seriously ill patients.
Fifth Hospital is one of the first medical institutions in Sumy region where an inpatient hospice and palliative care department was opened. Its work began in early 2023, but it has already gained authority, many positive reviews, and is in high demand, as such services are extremely needed in our society.
The Hospice and Palliative Care Department of the Fifth Hospital is located in Sumy at 2 Marka Vovchka Street, on the 2nd floor of the polyclinic building, where 15 specialized beds have been deployed.
An experienced healthcare manager, Director of the Fifth Hospital Viacheslav Petrenko, notes that the services of the new department are extremely in demand. He says: “The department is constantly full. Since the beginning of the year, nearly 300 patients have been treated here, which indicates the extremely intensive work of the professional team of the unit. Together with like-minded colleagues, we approached the creation of this inpatient department professionally and meticulously. Already at the stage of designing the capital renovation, we laid down the most modern standards for such a special department, guided by the strict requirements of the National Health Service of Ukraine and the desire to create the best possible conditions for people suffering from illness and pain.”
HUMAN CONNECTION. Senior nurse of the department Liudmyla Kuziava says that the staff pays great attention to psychological, spiritual, and moral support for patients and their relatives.
Dignified conditions and humane attitude
Indeed, the new department is cozy and comfortable, with dignified conditions created for staff, patients, and their relatives. Everything is well thought out—from specialized beds for bedridden patients, anti-bedsore mattresses, convenient bedside cabinets and tables for meals and medications, specialized sanitary rooms, to the most modern equipment. Namely: centralized oxygen supply to each bed, availability of advanced respiratory equipment to provide high-flow oxygen for invasive and non-invasive artificial lung ventilation (in respiratory disorders), a call button for staff installed near each bed, and electronic multi-monitors in hospital wards connected to the duty nurse’s computer at the station. Round-the-clock monitoring is carried out, and in the event of changes in the patient’s condition to critical indicators (body temperature, blood pressure, pulse, respiratory rate), the system automatically triggers an alarm and sends a signal to the duty nurse’s computer, indicating that the patient requires urgent assistance.
Head of the Hospice and Palliative Care Department Iryna Tsymbal notes that the unit strictly complies with the requirements of the National Health Service of Ukraine. Under the relevant package of medical guarantees, patients receive FREE treatment within planned hospitalization upon an electronic referral from a family doctor.
“Palliative patients are severely ill patients with incurable conditions and diseases, to whom we provide pathogenetic (supportive) and symptomatic therapy. We also treat chronic pain syndrome, select an individual observation plan and a treatment plan for the patient. All this is developed individually by the attending physician together with specialists of the multidisciplinary team,” emphasizes Iryna Andriivna and continues to explain the department’s work algorithm, which is still little known to the population. “The department has single, double, and family rooms. It is предусмотрено that, with the patient’s consent, if they need or wish, relatives may stay with them around the clock.”
The department also has a unit for providing medical care on an outpatient basis—a mobile palliative care team. It includes doctors of multidisciplinary specialties: an anesthesiologist, therapist, nephrologist, neurologist, ENT specialist, and surgeon. If necessary, consultations are provided by phone to both patients and their relatives regarding patient care, nutrition regimen, and correct medication intake. Of course, there is also a home visit service for patients who, upon referral from a family doctor, are receiving mobile palliative care (medical supervision, collection of clinical tests, electrocardiogram).
The medical staff of the department stands guard over patients’ health. Male nurse Ihor Shtykh and ward nurse Liliia Taran have experience communicating with and caring for “special” patients.
The patient has the opportunity to choose where they will die—at home or in a hospital inpatient unit. Or relatives may express their preferences. “Because there are patients who are not accessible to verbal contact,” says Iryna Andriivna. “In addition, we provide a ‘respite’ service when a patient wishes to take a break from the home environment or from family members. If necessary, social and legal support is organized, including assistance from a social worker, provision of spiritual support, inviting a priest, and discussing consent for posthumous organ donation.”
There are no simple cases here; all are quite severe
Doctor Anastasiia Kravchenia joined the department after extreme experience working during the COVID pandemic. She is a therapist in the inpatient hospice and palliative care department and the mobile palliative care service. “My work consists of symptomatic treatment of severely ill, dying patients,” the doctor notes. “Our patients are quite severe, with difficult life stories. As a rule, they have already seen all specialists and all medical institutions. But unfortunately, the diagnosis of their diseases is incompatible with life. That is, we work with patients whom no one else is able to help and who have an unfavorable prognosis. We do not treat the disease because it is incurable—we treat only symptoms. For example, nausea, vomiting, high fever, pain syndrome. Most patients in the department are oncology patients after chemotherapy with stage IV cancer. Sometimes people with decompensated heart failure come to us, when the heart muscle cannot cope with its function. The patient needs a heart transplant, but comorbidities do not allow surgery. There are also patients after stroke in a vegetative state who require either parenteral (via venous access) or enteral (via nasogastric tube) nutrition.”
According to Anastasiia Serhiivna, for bedridden patients in a vegetative state, it is necessary to calculate a nutritional ration. The caloric content of food is calculated according to the patient’s weight, taking into account body temperature, diuresis, and respiratory rate. It is necessary to calculate the optimal amount of fluid that the weakened body can consume, and these are quite complex mathematical calculations.
After a short pause, Anastasiia Kravchenia admits that the hardest part is moral. She continues: “Sometimes patients, looking straight into your eyes, ask a fateful question: ‘How much time do I really have left?’ It is difficult to answer such questions, but a person wants to manage to do something in this life if possible. At the same time, relatives sometimes cannot or do not want to understand that we are powerless to cure the patient, especially when there is severe pain, intoxication, the tumor is growing, and an irreversible process is underway. By all means, we try to alleviate their suffering; we manage to remove pain, and then the person wants to live—to wake up, look out the window, eat, communicate, read a book.”
Every working day is an exam in professional resilience, humanism, and heartfelt kindness
The department is staffed with experienced personnel. Senior nurse of the Hospice and Palliative Care Department Liudmyla Kuziava has 36 years of work experience. She begins her story: “Palliative care is introduced when all types of treatment become ineffective, when vital organs begin to fail. The goal of such care is to maximize relief from physical and moral suffering of the patient. This care also includes meeting equally important psychological, social, and spiritual needs.”
Equipping the department’s wards with modern equipment and contemporary furniture to ease the work of staff and improve the quality of services for patients.
Liudmyla Oleksandrivna supervises 14 nurses and 9 junior nurses. “Only experienced nurses are accepted here, those who have at least 8 years of work experience in general inpatient departments. They have practical experience with professional moral and physical stress, because our work involves almost daily extreme cases. Therefore, together with the head of the department, we pay great attention to establishing moral contact with the patient and their relatives,” explains the senior nurse.
With barely noticeable emotion, she says that very often patients arrive completely helpless and require attentive care, daily hygiene procedures, spoon-feeding 4–5 times a day, prevention of bedsores, and more. This is an extremely important part of care and at the same time individual for each bedridden patient. Liudmyla Kuziava says: “We provide care daily and meticulously. Credit must be given to our staff for their professionalism, conscientiousness, and accuracy. As for pressure sore prevention, to date none of our patients has been discharged with bedsores.”
One of the prerequisites for the coordinated work of the new department is shared experience during the COVID pandemic. Liudmyla Oleksandrivna’s colleagues admit that at first there was fear: would they be able to cope with work that requires moral endurance and sometimes suppression of personal feelings and emotions. They express a shared opinion: “It is hard to convey the deep wave of dramatic emotions reflected in the eyes of our patients, who physically cannot express themselves. And so day after day, month after month.” Liudmyla Oleksandrivna once again speaks with gratitude about her respected colleagues: “The initial period was especially difficult for the team, when we were mastering the specifics and professional subtleties of a new field of work. To support one another, every day we voiced a motto that inspired us and gave us confidence. We worked for a whole month, establishing the department’s workflow algorithm, together as a team. But we endured; no one quit, and today we all continue to work together, experiencing both successes and setbacks together. Kindly, patiently, and caringly, we look after our severely ill patients—and this is a great labor.”
rnP.S. When the issue was being prepared, a pleasant event occurred at the Fifth Hospital. The news concerns the improvement of the infrastructure of the Hospice and Palliative Care Department and the Comprehensive Rehabilitation Department “Slobozhanshchyna.” Namely, a pantry room was opened to organize the nutrition system for patients of the above-mentioned departments located nearby on the 2nd floor of the polyclinic building. The new service room has been fully renovated and equipped with modern and convenient kitchen equipment (set of dishes, food transport cart, etc.). This is a small but confident step forward—toward improving the institution’s work, easing the staff’s workload, and enhancing the quality of services provided to the population.
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Hospice and Palliative Care Department: Sumy, Municipal Non-Profit Enterprise “Clinical Hospital No. 5”, 2 Marka Vovchka Street, (0542) 662815.
Admissions Department, Emergency Medical Care Department: (0542) 66 28 35, +380 50761 09 26.
Working hours: Mon–Sun: 24/7
Registry: (0542) 66 28 17, (0542) 66 28 18, (099) 78 19 152
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Worth knowing
“Indicative criteria for hospitalization to the hospice and palliative care department, since not all patients with severe pathologies are subject to hospitalization. Main indications for hospitalization include: decompensated heart failure with reduced function, diabetes mellitus (which has led to functional disorders with chronic damage to internal organs), Alzheimer’s disease, disseminated atherosclerosis, multiple sclerosis, decompensated liver cirrhosis; however, the majority are oncology patients.”
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