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Skip to 0 minutes and 9 seconds The White-Yellow Cross is located in the province of Limburg. Limburg is one of 10 provinces in Belgium. It’s Dutch-speaking and has a population of over 800,000. It combines rural and urban areas and produces 50% of Belgian fruit. Coal mining was an important industry in the 19th century, but no longer, although some areas continue to have heavy chemical industries. The province of Limburg is served by the White-Yellow Cross nursing service for home care, and was founded in 1937. Its distinctive yellow and white cars, of which there are over 1,500 across Limburg alone, can be seen in the area, with nurses delivering care to patients in their own homes. We have dedicated nurses who see their own patients every day.

Skip to 1 minute and 0 seconds And when she recognises if one of her patients has no active treatment left and becomes palliative, that moment, the nurse is aware of this. She will discuss this at the nurses’ meeting or with the head of department or the specialist palliative care nurse. And when we decide he is a palliative care patient, we will discuss this with his GP so the GP can ask for the palliative care bonus payment. And at the same time, we can ask Pallium to be involved. Within the nursing team, there are nurses such as Hilde who have more specialist knowledge of palliative care patients. From the moment we are in the terminal stage, the palliative care nursing team will be arranged.

Skip to 1 minute and 45 seconds This means that we will work with four, or maximum six, home care nurses with this patient. We will then be available 24 hours on call, so also at night, but only for nursing care. The White-Yellow Cross nurses work closely with the specialist palliative care team, Pallium, which one of their doctors, who is also a GP, explains. Pallium is an organisation that gives support in palliative care at home, support for doctors, nurses, family members, patients, of course. Technical support, practical support, but a very important part is also emotional and psychological support at home. There are different ways a patient can be referred to the palliative care nurses at White-Yellow Cross. We have patients that we have been nursing for years.

Skip to 2 minutes and 51 seconds And then, as their home care nurse, we have to recognise when this patient becomes palliative.

Skip to 3 minutes and 0 seconds When I think of our COPD patients, our cancer patients, heart and kidney failure, and not to forget our demented patients, sometimes it’s very difficult to assess when they get into the palliative stage. We can also have new patients refer to our service who are already labelled as a palliative care patient, or patients referred who are imminently dying. These are the most difficult ones, because these patients are only with us for a very short time, so we did not have time to build a stronger relationship with them. In addition, they can get direct referrals from the palliative care team in the hospital.

Skip to 3 minutes and 40 seconds And if we do discharge a palliative care patient home, sometimes we invite the GP and the home care nurses of the White-Yellow Cross to discuss things– to discuss care, to discuss problems that may arise at home– so to anticipate on a discharge home. And otherwise, we phone them to tell this patient who will be discharged and explain the care he has received in the hospital and what could happen at home and what we expect the home care nurses to do at home. There are some aspects that work very well. The positive aspects of our work are that we can let people die at home. We know from statistics that a lot of people want to die at home.

Skip to 4 minutes and 28 seconds And this is something we are able to achieve most of the time. Continuity of care with our continuity team– we are available day and night. Then the GP can follow our daily assessments via the electronic patients’ record. So when we know it’s going to be a difficult situation, we will all meet at a department or in between, and certainly, at the end, to talk things through. To make the service work well, they have their own learning system, which means patients have quick access to anything they might require. We have our own loan service. So when we need anything urgently, we can have it within four hours. This could be a pressure relief mattress, or we have 30 syringe drivers.

Skip to 5 minutes and 16 seconds So all technical stuff we need– like a bed, side guards, anything really– we can obtain very quickly. White-Yellow Cross also run out of hours services, not only for their patients, but also to support other groups such as Pallium, ensuring the right referrals are made. The sheer coverage of the White-Yellow Cross teams is recognised by other health care professionals across Limburg, but there are other benefits. The good thing about the service is that it’s wide spread. It’s a big area they cover. And it’s very well-organised. They usually follow the patients for longer times, so they’ve known the patient and the family carer from before the patient has been labelled palliative. And usually, they can see the transition.

Skip to 6 minutes and 5 seconds So they usually have a very good connection, also, with the GP of the patient. And I think they’ve got a very good collaboration with the GP, but also with the hospital or with Pallium, the specialist palliative care team of Limburg. Communication between the White-Yellow Cross teams and the GP is crucial. Most of the information I read at home. It’s written down in the document that they leave there. It’s from White Cross themselves. But I also do a lot of calls at the headquarter of White Cross. And then they recall to me, or a lot of the discussion goes by telephone. Yeah. But the main points are, for most of the patients, at home in their documents there.

Skip to 7 minutes and 6 seconds However, there are always improvements to any service. And not surprisingly, this comes from communication with the hospital. The communication between GP and hospital is something that could be improved. Here, usually, we bridge the gap. Sometimes, palliative patients still go to the hospital for chemotherapy. And we have noticed that when the patient is still being seen at the hospital, the GP has lost him in follow up, without any information. But what is important– that we still do to daily nursing care for that patient at home, and that we will have regular contact with the GP and inform the GP how this patient is going, because when you encounter problems in the weekend, it comes in handy to have your GP.

Skip to 7 minutes and 53 seconds Team meanings are crucial to the service, and are also used to debrief after a death. When the patient has died, we will have a debriefing in our department where we will invite everyone who has cared for this patient– the health care assistants, the professionals from Pallium, not to forget the GP– so we can sit around a table, hear what went well, and what we could learn from. At a debriefing following death, we often learn from the experience which could be applied to the next palliative care patient we care for. Every situation is different. You always learn something from it. But you’re not sure if you can use it in the next situation, because every time, it’s very different.

Skip to 8 minutes and 42 seconds This is a predominantly home-based nursing service which has been integrated well with the local GPs, hospital staff, and the specialist palliative care team, Pallium.

Effective practice in palliative care: An example from Belgium

This final section of Week 2 presents a further two examples of palliative care services in Europe, featuring interviews and discussions with the very people involved in the provision: patients, volunteers, and healthcare professionals.

This week’s first example is that of White Yellow Cross, located in the province of Limburg in Belgium. White Yellow Cross is a predominantly home based nursing service which has been integrated with local GPs, hospital staff and the specialist palliative care team.

As you watch the film, consider what you think are important features in this service example.

You can also read about Peter and Yvonne’s experiences on page 15 in Integrated Palliative Care.

Additional reading

Further examples of integrated palliative care across Europe are available in the free book which accompanies this course (see ‘Downloads’ section at the bottom of this page).

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This video is from the free online course:

Palliative Care: Making it Work

Lancaster University