Changes in demographic patterns and the burden of chronic illness have challenged palliative care clinicians to engage populations other than those with malignant disease. This new paradigm has promoted the development of a population based approach to service delivery which aims to extend the reach of palliative care to hard to reach populations, including older people in residential aged care. In Australia, the high levels of disability and death experienced by older people in this care setting has resulted in policy promoting the delivery of a palliative approach to care. Achieving health care reform in this complex health care environment has traditionally been difficult to realise due to a range of workforce, training, funding, variable organizational philosophies and legal factors. The “Residential - Palliative Approach Competency” (R-PAC) Project aimed to collaboratively develop, implement and evaluate a sustainable model of care to facilitate the delivery of a palliative approach to care for older people admitted to residential aged care facilities, in regional Australian. Action research, with a focus on improving care and involving participants, was used to promote the delivery of a palliative approach in residential aged care facilities. The R-PAC Project was designed to follow the action research sequence of reflection, assessment, planning, action and observation. Nested within the action research method are eight distinct but interrelated studies in a mixed method design. Study A, a focused needs assessment undertaken as part of the preliminary investigations, confirms that older people in aged care have unmet palliative care needs. The three studies conducted during Phase One provide a greater understanding of delivering palliative care in the residential aged care setting. Study B, a chart audit identified the strengths and gaps in end-of-life care provision in the local aged care setting. While, Study C identified that aged care nurses and care assistants are committed and compassionate about delivering palliative care but desired greater palliative care competencies. The palliative care attitudes, values and learning needs of aged care providers were explored in greater depth in Study D. The data from these investigations guided the development and implementation of a multifaceted intervention during Phase Two. Following the implementation of the multi-faceted intervention and during Phase Three another series of investigations was undertaken to measure the impact of the collaborative intervention. Focus groups were used to determine the perceptions of aged care providers toward the multi-faceted intervention (Study E) and to seek the views of general practitioners (Study F). These data revealed that aged care nurses and general practitioners wanted to establish a more collaborative approach to care planning and delivery. The survey (Study G) and chart audits (Study H) were repeated in Phase Four in order to measure the impact of the action. The findings of the survey of aged care nurses and care assistants shown an increase in palliative care competencies, while the chart audit demonstrated positive trends in improving end-of-life care. Although, some aspects of care, particularly advance care planning and routine use of pain assessment tools required ongoing attention. This data propel the R-PAC Project into Phase Five and the development of a model of care to promote the delivery of a palliative approach, which was informed by the research findings. The R-PAC Project use of the action research method has facilitated a cascade of engagement and participation of all residential aged care facilities in this regional community and enabled practice innovation. The project has seen the sharing of valuable insights into usual practice and collaboratively engaging aged care nurses, care assistants and general practitioners in developing practical solutions to end-of-life care. This process has allowed for the acknowledgement and validation of the role of aged care providers, fostered personal empowerment and identified the importance of collaboration. This research has provided greater insight into the palliative care needs of people in residential aged care and collaboratively developed an intervention to improve the outcomes of older people. Study findings have also identified important issues requiring ongoing evaluation, particularly multidisciplinary team meetings and care planning. / Doctor of philosophy (PhD)
| Identifer | oai:union.ndltd.org:ADTP/235671 |
| Date | January 2008 |
| Creators | Phillips, Jane, University of Western Sydney, College of Health and Science, School of Nursing |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
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