Provide Palliative Care
The Principles of Palliative Care
Palliative care is integrated into a resident’s overall care, as well as the care their family receives. The document, ‘Principles for Palliative and End-of-Life Care in Residential Aged Care’5 provides details supporting each of the following principles:
1. Consumers' physical and mental needs at the end of life are assessed and recognised
2. Consumers, families and carers are involved in end of life planning and decision-making
3. Consumers receive equitable and timely access to appropriate end of life care within aged care facilities
4. End of life care is holistic, integrated and delivered by appropriately trained and skilled staff
5. The end of life care needs of consumers with dementia or cognitive impairment are understood and met within residential aged care
6. Consumers, families and carers are treated with dignity and respect
7. Consumers have their spiritual, cultural and psychosocial needs respected and fulfilled
8. Families, carers, staff and residents are supported in bereavement5
Following the Palliative Care Needs Assessment
After assessing a resident’s palliative care needs:
- Check history of symptoms and previous treatments received and their effect.
- Determine the effect of the problem on the resident’s normal activities and daily function.
- Consider treatment options.6
Next Actions:
- Agree and implement a care plan with the resident (and their family) and the multidisciplinary team.
- Establish whether these symptoms can be managed by the current treating team.
- If severe problems are identified or anticipated, consider referral to the specialist palliative care service or specialists within your service (e.g. Nurse Practitioner).5
The resident’s care plan should be updated to reflect their palliative care needs. The four domains identified in the Assessing Palliative Care Needs section of the toolkit are also used in this section to highlight how to meet the palliative care needs of the resident and their family.
ELDAC Toolkit Educational Video
Watch the ELDAC Assess Palliative Care Needs educational video will help you to describe the importance of person-centred and holistic assessment; identify the four domains of wellbeing used in palliative care assessment and recognise the importance of care planning to support end of life care.
This section has a range of links that provide a range of information on common symptoms:
Difficulty Sleeping
Fatigue
- CareSearch Clinical Evidence has information on fatigue.
Appetite Problems
Oral Care
- palliAGED has downloadable Practice Tips on Oral Care for Nurses (pdf 236kb) and Careworkers. (pdf 441kb)
- South Australia Health has a comprehensive guide called Better Oral Health in Residential Care (pdf 7.4MB). This resource was designed in undertaking oral health assessment and care planning for people in residential aged care.
Nausea
Bowel Problems
- CareSearch Clinical Evidence has information on bowel problems.
- palliAGED has downloadable Practice Tips on constipation for Nurses (pdf 393kb) and Careworkers (pdf 433kb) as well as tip sheets on faecal incontinence for Nurses (pdf 233kb) and Careworkers. (pdf 353kb)
Dyspnoea (Breathing Problems)
Skin and Wound Care
- palliAGED has downloadable Practice Tips on Skin and Wound Care for Nurses (pdf 263kb) and Careworkers. (pdf 371kb)
Pain
Delirium
Dementia Care
Anxiety
- CareSearch Clinical Evidence has information on anxiety.
- palliAGED has prescribing information for anxiety and downloadable Practice Tip sheets on anxiety for Nurses (pdf 353kb) and Careworkers. (pdf 424kb)
Depression
- CareSearch Clinical Evidence has information on depression.
The Palliative Care Needs Assessment Guidance (pdf 2.3MB) has information on all four domains and considers the whole family as the unit of care. There are suggestions on the approach to take; identification of symptoms and concerns with example prompts for the assessor; and suggested actions to take.
When assessing a person with life-limiting illness it is important to understand their concerns in relation to home, family and community; and to identify risk in relation to their independence and social functioning.
palliAGED has downloadable Practice Tips on Talking about Dying for Nurses (pdf 315kb) and Careworkers; (pdf 454kb) Continuity of Care for Nurses (pdf 268kb) and Careworkers; (pdf 437kb) and Case Conferences for Nurses (pdf 340kb) and Careworkers. (pdf 431kb)
The Palliative Care Needs Assessment Guidance (pdf 2.3MB) has information on all four domains including suggestions on identifying psychological and emotion issues residents may have. People with life limiting conditions frequently have psychological concerns. In order to identify these concerns, it is essential that the assessor is proactive in asking about emotional and psychological issues. Concerns may include:
- Mood and interest
- Adjustment to illness
- Resources and strengths
- Uncontrolled multidimensional
- Pain (total pain)
- Pre-existing mental illness
CareSearch has webpages with additional resources on
anxiety and depression. (Domain 1 – Physical Wellbeing (above) has information on Anxiety and Depression.)
Knowing and understanding the resident’s cultural beliefs will help careworkers be more sensitive to the resident’s and family’s needs and traditions. Careworkers will be better able to show respect, which helps provide good end-of-life care.
palliAGED has downloadable Practice Tips on Spiritual Care for Nurses (pdf 270kb) and Careworkers. (pdf 340kb)
The Agency for Clinical Innovation has a video the place of spiritual care at the end of life.
Palliative Care Australia (PCA)
Palliative Care Australia has a comprehensive website devoted to palliative care resources. Some of these include:
- General brochures for families explaining palliative care and there are multilingual care brochures available in 17 community languages. Further resources in downloadable and printable format are also available.
- A factsheet on palliative care myths (457kb pdf) for residents and families.
- A downloadable pdf on pain and pain management (599kb pdf).
The PCA website has a section called ‘Understanding Palliative Care’ that includes information on:
The PCA website has a ‘Support and Services’ section that offers information on:
Department of Health
The Department of Health has a website devoted to palliative care and end of life care. There is a short video called “Talking about Palliative Care” featuring people from diverse cultures chatting about end of life care. While not specifically featuring people living in residential aged care it might be useful to show other staff or families.
CareSearch
CareSearch has also a webpage about residents wanting to talk with someone – in terms of finding the right person, professional help or support group.
PalliAGED
The PalliAGED website has collated a comprehensive list of resources for the family on palliative care and end of life needs including topics on:
- Palliative care
- Advance care planning
- At the very end of life
- Bereavement, grief and loss
- Carers
- Complementary therapies
- Discussing palliative care
- Funerals
- Medicines
- Pain
- Residential aged care
- Symptoms other than pain
There is a webpage on communication at the end of life that has resources to assist in communicating with families, especially at such as emotional time.