Guidelines for a Palliative Approach in Residential Aged Care

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geropsychologist A geropsychologist is a psychologist who specialises in the assessment and management of older persons. Geropsychologists provide assessment, consultation and intervention services related to psychological adaptations in later life (e.g. adapting to age-related changes, bereavement), psychopathology (e.g. affective disorders, dementias), behavioural problems (e.g. wandering, aggressive behaviour, behavioural aspects of incontinence); problems in daily living (e.g. marital and family problems, coping with acute and chronic stressors); medical and legal decision-making capacity (e.g. legal guardianship); independent living arrangements; behavioural competencies (e.g. driving, management of medications, selfcare skills, financial management); and socio-cultural and socioeconomic factors influencing the experience and expression of psychological problems. Distinctive interventions include reminiscence and life review therapies, grief therapy, expressive therapies and psychoeducational programs for family caregivers. graseby pump A Graseby pump is a battery-powered syringe driver designed to administer a predetermined dose of injectable medication, usually opioids, over a specified period. informed consent In Australia, no medical services can be provided without the consent of the person concerned. This consent is considered informed consent when the person agrees to a treatment without duress, voluntarily gives their consent after a reasonable time, and has been provided with adequate information. The only exception to this is when the person’s capacity to consent is impaired by a serious mental illness, in which case the relevant State Mental Health Act can be invoked. If a family member has been granted a legal right to make decisions for the resident, then the form stating this must be sighted by a member of the aged care team and its powers and limitations noted on the resident’s record. The aged care team can then be directed by this document as to how much information they are able to share regarding the resident. As the legislation may vary regarding the responsibilities of people who are authorised ‘in advance’ by the resident as ‘Enduring Power of Attorney’ (financial or medical) or ‘Enduring Power of Guardianship’, it is incumbent upon each RACF to check legal requirements. medical power of attorney Medical power of attorney is the title given to a person who is legally appointed to make decisions relating to the medical care of another. Managers of RACFs are directed to seek independent legal advice regarding medical power of attorney. Guidelines for a Palliative Approach in Residential Aged Care 219
multidisciplinary team Multidisciplinary teams consist of a mix of aged care, health and social welfare disciplines. Team members share common goals, collaborate, and work interdependently in planning, problem-solving, decision-making, implementation and evaluation. Members of a multidisciplinary team could include GPs, surgeons, medical or radiation oncologists, Aboriginal health workers, nurses, care assistants, coordinators of volunteers, dentists, optometrists, psychiatrists, psychologists, social workers, physiotherapists, chaplains / pastoral care workers, volunteers, pharmacists, occupational or speech pathologists, or palliative care specialists. National Consultative Information-Sharing Network (NCISN) The National Consultative Information-Sharing Network (NCISN) was a network of people who provided services in the aged care or palliative industry and who indicated that they were willing to be involved in the APRAC Project. NCISN members elected to contribute online their experiences and thoughts regarding a palliative approach for residents in RACFs. To participate in the NCISN, individuals completed an online registration at www. apracproject.org. non-pharmacological interventions nurses Non-pharmacological interventions are treatments that do not use drugs to alleviate symptoms of the disease. Examples of non-pharmacological interventions include music or art therapy, exercise, transcutaneous electrical nerve stimulation (TENS), massage, aromatherapy and support groups. In Australia there are currently two levels of nurses, the Enrolled Nurse (EN —trained through the vocational education and training sector) and the Registered Nurse (RN — university trained). The development of a higher level within the RN group, the nurse practitioner, is also at varying stages of development depending on the State or Territory. Its distinctive traditions, skills, knowledge, values and qualities define nursing practice. The use of the title ‘nurse’ is legally protected in all states and territories. When the term ‘nurse’ is used in this document, it refers to anyone appropriately qualified as a nurse, such as the following groups (this list is not exhaustive): • Nurse practitioners, nurse managers, nurse educators • RNs (general, specialist, Div 2), and • ENs (RN Div1 in VIC). oncologist An oncologist is the specialist title of a doctor who treats cancer. 220 Guidelines for a Palliative Approach in Residential Aged Care
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Guidelines for a Palliative Approac
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NHMRC APPROVAL These guidelines wer
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4 ADVANCE CARE PLANNING 55 4.1 Impl
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16 MANAGEMENT’S ROLE IN IMPLEMENT
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17 Ann and Mr Wells’ family Helpi
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IMPORTANT NOTICE On 8 December 2005
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achieved for these guidelines from
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facets of a palliative approach are
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Additional levels of evidence The N
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Guidelines Ref No. Evidence level A
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Guidelines Ref No. Evidence Cachexi
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Guidelines Ref No. Evidence Anxiety
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Guidelines Ref No. Evidence 70. Und
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1.1.1 Aims The aims of the systemat
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Table 1: Search terms Terms Aborigi
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1.1.5 Exclusion Criteria Although t
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in the methodology that may invalid
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To ensure the reliability of the re
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1.2.2 Methodology When the first re
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1.4.2 Method When feedback was requ
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Several Working Party members conve
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or disagreed with each stakeholder
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All the feedback received was colla
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CHAPTER 2 A PALLIATIVE APPROACH A s
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• Profound weakness • Trouble s
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• Has the resident had a recent d
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in the RACF rather than transferrin
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palliative care teams is more appro
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or ageing progression (see Table 4)
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Table 7: A practical model of socia
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Vignette 2: Robert’s story Robert
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CHAPTER 4 ADVANCE CARE PLANNING Car
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efore discussing the advance care p
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• A change in their health status
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CHAPTER 5 ADVANCED DEMENTIA Advance
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A study was conducted to investigat
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5.3.2 Acute illness One study found
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Vignette 5: Anna’s story Anna was
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(see Fainsinger, Miller and Bruera
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Dame Cicely Saunders first describe
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Table 8: Common myths about pain ma
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6.2.4 Breakthrough pain The term
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Pain can lead to behavioural change
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Vignette 7: Mrs Harris’ story Mrs
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examined the addition of paracetamo
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provision and storage of drugs, whe
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successfully tested predominantly w
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The reasons for malnutrition in old
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The diets of residents should also
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To assist in such a discussion, a d
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appear until dehydration is far adv
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Guideline: Hydration 24. Recommenda
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6.7 NAUSEA AND VOMITING Nausea is t
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• Do you have any problem control
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6.9.1 Assessment A thorough oral as
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6.10 SKIN INTEGRITY The major skin
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Wounds can occur in residents for a
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Brocklehurst and colleagues (1999)
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medication treatment along with non
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• CAM therapies may be culturally
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word games, the present day, and fa
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CHAPTER 7 PSYCHOLOGICAL SUPPORT A r
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7.1.1 Death statements and depressi
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the factor structure of the CSDD. I
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7.2.2 Management Non-pharmacologica
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Table 17: Distinguishing delirium f
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is recognised that in many rural an
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important [305] (Level QE). Familie
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8.4 FAMILY INVOLVEMENT The role of
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CHAPTER 9 SOCIAL SUPPORT, INTIMACY
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Rather than denying the existence o
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9.2.2 Management Imaginative progra
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Guideline: Social Support Social Su
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include lack of information about t
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CHAPTER 11 CULTURAL ISSUES Australi
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11.2 Assessment The best approach t
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CHAPTER 12 SPIRITUAL SUPPORT Dein a
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Vignette 13: Jack’s story Jack wa
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Guideline: Spiritual Support 68. A
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interpersonal and leadership skills
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CHAPTER 14 END-OF-LIFE (TERMINAL) C
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mood (61%), constipation (59%) and
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e relevant, and may even worsen sym
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Treatment involves changes in posit
Page 182 and 183: 14.5 PREPARING FOR IMMINENT DEATH
Page 184: education of the aged care team and
Page 187 and 188: Table 21: Grief, loss and bereaveme
Page 189 and 190: • excessively avoiding tasks remi
Page 191 and 192: Vignette 18: Reflections When provi
Page 193 and 194: may have been able to contribute to
Page 196 and 197: CHAPTER 16 Management’s role in i
Page 198 and 199: REFERENCES 1. World Health Organiza
Page 200 and 201: 31. Hanson, L. C., Danis, M. & Garr
Page 202 and 203: 60. World Health Organization Quali
Page 204 and 205: 89. McCarthy, M., Addington-Hall, J
Page 206 and 207: 121. Saunders, C. M. (1998). Forewo
Page 208 and 209: 150. Sindrup, S. H. & Jensen, T. S.
Page 210 and 211: 177. Berry, E. M. & Marcus, E.-L. (
Page 212 and 213: 208. Robinson, S. B. & Rosher, R. B
Page 214 and 215: 237. Brocklehurst, J., Dickinson, E
Page 216 and 217: 265. Barraclough, J. (1997). ABC of
Page 218 and 219: 295. Brown, T. M. & Boyle, M. F. (2
Page 220 and 221: 328. Kristjanson, L. J., Leis, A.,
Page 222 and 223: 360. McGrath, P., Vun, M. & McLeod,
Page 224 and 225: 392. Saunders, C. M. & Baines, M. J
Page 226 and 227: 424. Rawlings, D. & Glynn, T. (2002
Page 228 and 229: Glossary acetaminophen Acetaminophe
Page 230 and 231: coordinator of volunteers coping A
Page 234 and 235: opioids Opioid is a specific term u
Page 236: specialised palliative team A speci
Page 239 and 240: Ms Wendy Shiels Dr Jane Sims Dr Chr
Page 242: APPENDIX B The Australian Governmen
Page 245 and 246: APRAC GUIDELINES: EVIDENCE EVALUATI
Page 247 and 248: APRAC GUIDELINES: EVIDENCE EVALUATI
Page 250 and 251: APPENDIX F: Summary of the frequenc
Page 252: APPENDIX G: An example of how the g
Page 256 and 257: APPENDIX I: Resource list PALLIATIV
Page 258 and 259: Psychological Challenge Depression
Page 260 and 261: APPENDIX J: Examples of advance dir
Page 262 and 263: Schedule 1 MEDICAL POWER OF ATTORNE
Page 264: APPENDIX K An example of a Genogram
Page 268 and 269: INDEX Abbey Pain Scale 64, 71, 78 A
Page 270 and 271: evidence levels 5, 6, 20, 21, 22 ev
Page 272: andomized controlled trials 5, 21 R
Page 275 and 276: Palliative Care Australia PO Box 24
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