The key to any company’s success is for its employees to work together seamlessly and have successful interdepartmental communications. A great way for that flow of conversation to begin is to get to know significant figures in our Gulfside community. Each month, a different employee that has made a big difference at Gulfside will be chosen to be interviewed and featured in this blog. This month, we are happy to introduce some figures of Gulfside’s palliative care team: Kim Fantasia, APRN, and Stephanie Sutton, MSW, Registered Clinical Social Work Intern, Social Worker.
Meet Kim Fantasia, APRN
Meet Kim, a Gulfside Palliative Care nurse practitioner. She may not have always seen herself as having this role, but the journey leading up to where she is today has given her a beautiful testimony as to why working in palliative care can be so important to so many. Today, Kim is a skilled practitioner who is passionate about providing the best possible care to her patients and their families. During our interview, Kim was asked about her previous roles and explained how she got to Gulfside.
"I had been doing wound care for a number of years and had kind of gotten to the point where there really wasn't much further for me to go. It's kind of at the top level and I was looking for something else to just keep my interest piqued. With wound care, it's pretty typical that we work with patients where their wounds are not going to heal because of the health issues that they have. So, we would turn those patients over to the hospice and palliative team. I was getting to know the providers and learning about what they were doing and realizing that it's not about no treatment. It's about looking at health issues in a different way and maintaining comfort. I thought that that was really fascinating. I realized that it's a lot more complex than I thought, and actually bringing people comfort is very, very rewarding. It's not about sadness."
Meet Stephanie Sutton, MSW, Registered Clinical Social Work Intern, Social Worker
Meet Stephanie, a member of Gulfside's social work team for Palliative Care. She works tirelessly to address the physical, emotional, and social needs of patients. Palliative care social workers help patients and their families navigate the healthcare system, connect with community resources, and coordinate care. She also provides counseling and emotional support to patients and their loved ones, and helps them cope with the challenges of serious illness.
"I think for me, a lot of it has to do with the rewarding pieces of both hospice and palliative care. Not just that it's at end of life, that it's a new diagnosis of cancer, or somebody who has been living with Parkinson's for 20+ years, getting to hop along on their journey and really look at how we can increase quality of life while decreasing symptoms. You meet the patient or client where they're at. We get to meet them in their disease process and really get to embrace their autonomy to make their decisions about what their treatment is going to look like at this time, at this point in the game."
Having Difficult Conversations in Healthcare
Working for a palliative care clinic brings a lot of difficult conversations between the practitioners and the patient or their family. Approaching these topics is a skill that Kim and Stephanie have honed over the years.
Kim: "It's just trying to be gentle. In order for me to understand where a patient is at, I usually ask them, ‘what is your understanding from your specialist?’ Typically, because I've read their records, I usually have a good sense as to where a patient really is in their disease course. As they're talking, if I get the sense that they are not understanding really what's going on, then it's about a gentle approach. I try to do a little bit of education as to what their disease process is, being careful not to completely negate what they've understood from their specialist. Then from my approach, I try to help them understand medically what things mean, or just kind of maybe reframe where they're at in their disease course. It's not unusual for patients to think that because they're getting chemotherapy, there's a cure. And that's not always the case."
Stephanie: "Like you said, we're tailoring it back because we are developing that rapport for them to be able to trust us within their team. I look at some patients that have been with us for years, and the trust that they do have in us, that we are able to have those difficult conversations. They know that they're going to get the compassion and empathy that they come to expect almost from our conversations. We do have really difficult conversations."
Kim and Stephanie have difficult conversations with patients every day, meaning they need to build strategies to establish trust and build a relationship between them and their patients. When they were asked how they accomplish this, Stephanie quickly and excitedly said, "Animals."
Kim: "Yes. Talking and sharing some of our animal stories because we're animal lovers or showing a picture of our dog or something. There's just lots of things. If patients start talking about travels, it's not unusual for us to bring up a special travel thing. I think when patients sometimes get that sense that we're human. We don't just sit in this office day in and day out and then go home and sleep. We do have outside lives. I also think when we're able to share a little bit about what we're doing. I think that allows patients to feel more able to open up. Honestly, the fact that we let them talk about things, too. If I'm in a primary care office, my primary care provider doesn't have time to listen to me talk about my travel experiences. They've got things that they've got to touch on during my appointment and then they've got to move on, but we do have that luxury. We can let patients talk a little bit about those experiences and then it does start to open up that comfort level. Being able to just connect with people on that, like, real level and not just about health, I think is huge."
Stephanie: "Right. I think the big thing when I'm doing the biopsychosocial assessment, getting to hear where they're from and all that. So many of us are not from Florida, so we get to ask questions about the patients from Montana or Virginia, wherever. That seems to be a common bonding conversation that a lot of us have down here."
Creating a Plan of Care Together
Like any job, there are difficult moments that turn into some of the most rewarding lessons. Stephanie and Kim shared a story about a recent patient who had a difficult care process, but with teamwork and determination, the Gulfside Palliative Care team was able to create a compassionate and thorough plan of care.
Kim: "We had a situation where we were dealing with a patient that had a slightly different culture, where in their culture, pursuing all aggressive treatment avenues is very important. In that particular culture, they look at it like God wouldn't have put this intervention in place if we weren't supposed to try to use it. Our approach was making sure that we were supporting the family with those decisions. At the same time, when it became clear that this patient was declining very significantly and that these interventions were actually causing more harm than good and the patient was approaching end of life, hospice was difficult for them because of just their cultural beliefs. So we did stay on board, but it was about allowing the family to talk, allowing the patient to talk and have the family hear what the patient was saying from his perspective. Then being able to just support and reiterate that to the family, I think was helpful. Another big aspect is this patient was in and out of the hospital, and we were able to communicate with our palliative care colleagues at the hospital. They were able to communicate with us when he was being discharged, so we could do that continuity of care. We were trying to keep open lines of communication with everybody in the team so that when he was in the hospital, there wasn't different things occurring."
Stephanie: "I think being able to allow them to let us in, to be able to navigate with them, not for them, but with them. We could provide them all of the information that they needed to make the decisions. That was a really heavy case."
After walking families through difficult cases like that one, Kim and Stephanie are grateful for the support and resources provided to them, like all team members, by Gulfside.
Kim: "It was a really heavy case. And I will say that not only was it a heavy case for us, but then afterwards, it was really beautiful because all of us were very involved with this and it was just emotionally just very hard. But Gulfside did an extra supportive thing for all of us that were involved. We met with one of our social work colleagues who just helped us as a team process through our feelings. It was a lot and we were glad that we were there for that family. But also emotionally, whenever you're dealing with anyone that's dying, it's hard. Particularly when it’s a young person that's the same age as you, that has a similar family structure. But Gulfside allowed us all to process that and work with one of our colleagues just to help hear how we were doing. I thought that was really great."
Palliative Means Caring for the Whole Person
Palliative care is so much more than a medical treatment, at Gulfside, we care for the patient's emotional and psychological needs as well.
Stephanie: "We do a lot ongoing assessments of their needs, where they're at with their health, looking at everything. If they're married, is the spouse continuing to work? Is that where their income is coming from? Now their disease has progressed and needs further treatment – is that spouse not working? So I think managing emotional and psychological needs, a lot of it is just reassessing where are they and providing education of community resources. What would they benefit from? Anything from resources of food banks to the Area Agency on Aging to get extra help in the home to support caregivers."
Kim: "From my standpoint, when you have a certain disease, what is the disease trajectory? So, for example, somebody that has Alzheimer's, we start to prepare the family about what types of things to be expecting. At some point, your loved one is probably going to have confusion. Do you have safety features set up in the home to prevent mom from accidentally getting out of the house and potentially getting hurt? Do you have things like life alert in place? If your loved one is at home alone for a period of time because you’re at work, but they were to fall, do you have a way of that person being able to immediately call for the help that they need? It’s about anticipating some of those needs."
Requesting Palliative Care
If you or a loved one are living with a serious or chronic illness, the Gulfside Palliative Care team is here to help you and support you through your plan of care and decision making. Our team works alongside your primary care physician and specialists to make sure you are receiving well-rounded, comprehensive care.
For more information or to request a consultation with the team, please contact us at 800-561-4883 or visit Gulfside.org.
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