Nurse Advocate works to improve patient care

By Debora Steel, March 22, 2011

Pearl Dorward (in blue top and black vest) is the First Nations Nurse Advocate at the West Coast General Hospital. She works with hospital staff to ensure that Aboriginal clients get the best care possible from an often foreign system of care.

Port Alberni — 

Pearl Dorward recites a prayer at the beginning of each day. She says it grounds her in a good space to fulfill her role as the First Nations Nurse Advocate at West Coast General Hospital (WCGH).

“If I don’t, my day doesn’t go right,” she says.

It’s just before 7 a.m. and it’s quiet in the atrium environment of the main square of the hospital. Water trickles from a nearby water feature, and the overhead lights hum as people, waiting to get their blood work done, speak in hushed tones.

Pearl checks her computer and sees she has a couple of appointments after her rounds. A young mother whose newborn needs follow-up care is required to sign papers and needs help to secure travel funding. A Nuu-chah-nulth patient is confused about his doctor’s strategy for dispensing his pain medication. Pearl will meet with doctor and patient together to help them better understand the other’s perspective and concerns.

Each day brings new challenges with new situations, and the nurse advocate is there to help guide people through their often confusing and challenging involvement with the healthcare system, from the minute they walk through the door to the aftercare they’ll need when they make it home.

From the celebration of a baby’s birth, to extreme patient illness, to emergency situations like car accidents, even death, the nurse advocate must be able to help families navigate the often foreign environment of the hospital.

Ellen Brown, the Site Director at WCGH, calls Pearl a way-finder.

Brown describes the First Nations Nurse Advocate’s role as pivotal. She can’t imagine, Brown said, trying to provide hospital services without someone in that position, who is a link to the community, understanding of both the First Nations culture and the culture of health care.

Pearl not only provides great comfort and support in often very stressful times, she’s knowledgeable about the services available to clients once they leave the hospital environment and travel home to sometimes remote locations, said Brown.

“Pearl is there to set things up.”

Family pictures adorn the walls of Pearl’s comfortable office in the hospital’s main square. Fine art mingles with health posters. Their messages are diverse: “It’s everyone’s duty to act on adult abuse and neglect,” one reads, for example; the words ‘maa mush’ mean breastfeeding in the Nuu-chah-nulth language, reads another.

Pearl has worked in the nurse advocate position for about five years, now. After working for many years in medical surgery, and 10 years with psych patients, she started to provide relief work in the position when her sister Ina Seitcher was the nurse advocate.

When Seitcher went on to become the Nuu-chah-nulth Tribal Council Home Care Supervisor, Pearl applied for and was given the job fulltime.

Pearl admits that she leaned heavily on her sister’s experience for the first while, until she became fully confident that she knew how to deal with each situation as it would arise. Now it’s not only confidence she exudes as she goes about her day’s activities, she’s obviously in love with the job, and it shows in her interactions with her hospital patients and the other staff.

When asked why a First Nations Nurse Advocate is an important role to have in the hospital setting, Pearl quotes a man she met in the course of her work. Aboriginal people want to know that a “brown-skinned” friend is there standing beside them.

Some people come to the hospital and they have no family close by to just hold their hand. She said one man who attended the hospital just wanted Pearl to sit by his side, and that’s what Pearl did. Put everything aside, because he was afraid and he needed her.

Sometimes the job calls for babysitting a child while a young mother goes in for an ultrasound. Sometimes the job is about providing hospital staff with workshops to increase their understanding about First Nations people and, in the process, improve cultural safety for aboriginal hospital clients.

Some days are really hectic, Pearl said, and very stressful.

But when it slows down, she takes time to visit with Elders who are alone in the city, checking in on them to see how they are coping, doing some foot care or whatever she can for them.

Pearl reports to the Nuu-chah-nulth Tribal Council, but her role is funded by the Vancouver Island Health Authority. She is an integral part of the hospital team, said Brown, adding a hospital stay can be a very dramatic event in a person’s life.

Pearl is called to manage the times when people’s lives are being turned upside down, and she helps prepare for sending patients home to places where resources can be few and far between.

The plan for discharging a patient begins the moment he or she comes through the door, said Pearl. And the nurse advocate is a part of the team that helps navigate those waters.

On Pearl’s desk is a green plastic toy dinosaur. It sits next to an abalone shell filled with willow fungus smudge. There’s a green tomato desk clock with feet, and a gremlin doll. A cedar rose is pinned on a corkboard next to a dreamcatcher made of leather, beads and feathers. A china doll dressed in pioneer attire sits atop a book hutch which holds a variety of publications and binders with names like “The Drug Guide” and “HIV/AIDS and Hep C.”

Pearl explains that there is a lot of paperwork associated with the job of nurse advocate. She keeps two notebooks to chart information on the people she sees during the day.

At 8 a.m. it’s time for her rounds and she makes her way through to the medical/surgical care centre where she looks over the charts of patients who have been admitted.

She enters an elderly woman’s room, sits next to her on the hospital bed and gives her a hug. Pearl tells the patient how happy she is to see her out of the Intensive Care Unit and that she is eating. They talk quietly as nurses scurry in and out of rooms, changing the dressings on people’s wounds, preparing to transfer patients out to other hospitals. In this busy world, the nurse advocate can be a life raft in a turbulent sea of sickness and suffering.

The usual machines that roll and beep clutter hallways. Meds are being dispensed, and IV poles stand at attention ready for service. Pearl writes some notes in her book as she exits a room. She listens more than she speaks, but when she comments it is to move the conversation along to how the patient is really doing in the hospital environment. Pearl listens to complaints and provides some advice. The patients’ concerns are Pearl’s concerns.
People wave to her as she goes by. She doesn’t rush, and her hugs are frequent. She spends 15 minutes here, another 20 minutes there. Pearl leans in as she listens to an elder’s story.

“Ah, she’s a sweet lady,” Pearl says as she comes out from the visit.

She goes into the section of the hospital called ambulatory care. The nurses sit at a raised round desk in the centre of the room and the patients are positioned in beds around that circle like the spokes of a wheel. Each bed is separated only by a curtain, and yet it is very quiet.

Pearl heads to one patient and sits by his bedside. She puts her hand on his wrist and speaks quietly to him. He’s not from around here. In fact, he’s a long way from his home in The Pas, Manitoba.

Sometimes it just takes sitting next to a patient to let them know that someone is there for them, especially if they are alone, without family or other supports.

After visiting with the hospital social worker it’s time to phone the new mom to see how she is making out with plans to get her baby to Victoria for treatment.  Dealing with patient needs is not always easy. As needs and wants change, so do the arrangements.

“Now it’s getting complicated,” Pearl says when she gets off the phone. She puts her face in her hands and laughs. Things were all planned. Now Pearl has to start over.

Pearl’s job requires her to liaise with other NTC nurses. She’ll place referrals with the mental health program, with Usma. She’ll meet to discuss signage in emergency, or advise and consult on protocols around death and autopsy. She’ll seek guidance on these and other subjects from elders, and work to increase cultural awareness in the hospital setting.

Without her or the position the continuity of service for First Nations people at West Coast General would be much more disjointed, says NTC acting nursing manager Chris Lemphers.

But regardless of how busy the nurse advocate becomes, it’s all in a day’s work. After charting her patient visits and chasing down a doctor or two for the required paperwork needed to complete some homecare, Pearl will say another prayer, thankful for the day in the job that she loves.

“Some people dream about retirement,” she says. “I never want to retire.”