Division of Palliative Care moves to brighter, more spacious facilities

Spacious private rooms easily allow patients to be joined by loved ones by day or night

At a ceremony on September 29 to inaugurate the new Palliative Care Unit at the JGH, Dr. Jean Zigby (third from left), Chief of the Division of Palliative Care, Head Nurse Kathia Dorcélus-Cétoute (centre) and Dr. Lawrence Rosenberg (third from right), President and CEO of CIUSSS West-Central Montreal, were joined by several CIUSSS officials and members of the division’s staff. (Click on the photo to enlarge it.)

To bring even more life-affirming brightness, physical comfort and emotional warmth to those receiving care, the Division of Palliative Care has moved to fully renovated facilities that enable staff to better fulfill the needs of patients and their families.

On September 29, a total of 13 patients were carefully moved out of the premises that the Division had occupied for about 25 years. They remain on the fourth floor of Pavilion B, albeit in a new location.

Each person was welcomed into a spacious, light-filled room of their own for care that includes symptom management, complex medical needs and end-of-life support.

Funding for the extensive renovations was provided by several generous donors, including the major benefactor, the Lise and Giuseppe Racanelli Foundation.

The new unit is the latest element to be completed in what is known as Phase 4, a $300‑million project to refurbish various areas of the JGH’s legacy building (the older sections of the hospital) by 2030.

Phase 4 was undertaken to fully renovate and repurpose the many spaces that were freed up when the JGH’s critical-care departments were relocated to the newly opened Pavilion K in 2014 and 2016.

Of key importance: Space, light and privacy

The key features of the renovation—a private room for every patient, much more space in each room, and an abundance of natural light—would be beneficial in a ward of any kind, but they take on added significance in palliative care.

Since conversations among the patient, relatives, friends and the healthcare team can often be quite intimate at the end of life, the need for privacy—the kind available in a private room—is particularly important, explains Dr. Jean Zigby, Chief of the Division.

“Having single-bedded rooms, each with its own bathroom, was one of our top goals from the outset,” he says. “From a practical perspective, private rooms also offer much better protection against the spread of infection among patients who are highly vulnerable.”

Since each of the new rooms is considerably larger than at the previous site, several visitors can keep the patient company at the same time in total comfort, adds Head Nurse Kathia Dorcélus-Cétoute.

In fact, as many as three people can spend the night in the patient’s room on custom-made cushioned benches or on a padded, pull-out armchair. Additional visitors can be accommodated in a designated family room.

Ms. Dorcélus-Cétoute says some patients are placed in bariatric beds, which are expandable and make it easier for family members to sit very close to the patient—an important aspect of palliative care.

In addition, she says, the bed is equipped with digital sensors that provide a great deal of information about the patient’s condition and movements.

For example, it can alert staff when a patient who is at risk for falling tries to get out of bed. For those who have the ability to walk independently, the technology can keep track of how often the patient gets out of bed and how much time they spend out of bed.

Mimicking the calming effects of nature

The presence of plenty of bright, natural light is “very important in helping people to feel awake and alive,” Dr. Zigby says. “It stimulates the central nervous system and is fundamental in helping to reduce delirium and maintain patients’ circadian rhythm (day/night cycles) as naturally as possible.

“There can be varying degrees of confusion as patients approach the end, and light helps them stay as clear-minded as possible for as long as possible.”

“Many people approach palliative care with apprehension, often associating it with darkness, despair or the notion of giving up on treatment at the end of life,” Ms. Dorcélus-Cétoute notes.

“Equally is important is the interdisciplinary team, whose expertise addresses the comprehensive needs of patients and their families.”

The natural elements of the Unit are evident not just in the ample daylight, but in the construction materials (blond wood panelling), the murals (suggestive of the seaside) and the shape of the light fixtures and many of the walls (curved wherever possible).

“In nature, straight lines are rare, so we try to minimize their use,” Dr. Zigby says. “Straight lines are energizing and stressful, while curves are relaxing. If you want to go fast, you travel in a straight line; if you want to relax, you wander around.”

Music Therapist Samantha Borgal, who played a significant role in helping to plan the aesthetics and the move, says great care was taken in designing a space to appeal to all of the senses, notably vision, touch and hearing.

For this reason, she continues, a new jacuzzi has been installed, giving patients the pleasure of being soothed all over by swirling water. Those who are unable to walk can be wheeled into the bathing room, placed on a lift and lowered into the water.

“People who get sicker as they get older are often touch-deprived,” Dr. Zigby says. “That’s why we’ve increased the opportunities for them to be touched by the people they love and to come into physical contact with many aspects of their surroundings.”

A sophisticated audio-visual set-up

Ms. Borgal says stimulating sound is provided through a high-quality speaker. The electronic set‑up in each room also includes a 65-inch, wall-mounted screen that enables patients to choose their preferred audio or video programming.

“Our objective is to increase the level of comfort and, as much as possible, to normalize the environment in the patient’s room,” she adds.

Ms. Borgal proudly mentions that the support of donors has made it possible for Palliative Care at the JGH to be one of the few such departments in a Canadian hospital to have its own full-time music therapist and part-time art therapist. At most other sites, only one of these professionals is on hand.

Integral to the planning and development process has been the input of staff, says Ms. Dorcélus-Cétoute. Now they stand to benefit from the same features that are intended for patients: more space to administer care, as well as brighter and more pleasant conditions to tend to the needs of patients and their families.

In addition, employees have more room for administrative tasks, additional storage space for healthcare equipment, a new conference room and a larger, more comfortable lounge equipped with advanced technology and amenities.

Ms. Dorcélus-Cétoute says much of the latest progress has been possible, thanks to the invaluable contributions of two key individuals: Dr. Bernard J. Lapointe, O.C., the founding Chief of the Division, who died earlier this year; and former Head Nurse Bessy Bitzas.

“Many patients wish they could die at home, but for various reasons, that just isn’t practical or possible,” says Dr. Zigby. “What we try to do—and can now accomplish more effectively than ever—is create the next-best environment to their own home, where they can enjoy life and be surrounded by those who mean the most to them.”