Guidelines for a Palliative Approach in Residential Aged Care

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APPENDIX B The Australian Government Project Reference Group — Terms of Reference and Membership TERMS OF REFERENCE The project reference group will assist the project to achieve its objectives by: 1. Providing comment and input to the overall project plan 2. Providing appropriate guidance and support for the project by ensuring the needs of their sectors are being addressed 3. Providing comment on reports and other deliverables. MEMBERSHIP Dr Joanne Ramadge (Chair) Ms Maria Bohan Mr Michael Darragh Ms Rita Evans Associate Professor Sally Garratt Emeritus Professor Ian Maddocks Professor Margaret O’Connor Ms Jill Pretty Ms Alma Quick Mr Ian Reed Advisor, Ageing and Aged Care Division Australian Government Department of Health and Ageing Executive Director Carers Victoria Representing Australian Nursing Homes and Extended Care Association Director, Palliative Care Section Australian Government Department of Health and Ageing Representing Royal College of Nursing Australia — Aged Care Nurses Flinders University of South Australia Representing Royal College of Nursing Australia — Palliative Care Nurses Manager, Policy and Consultancy Aged Care Services Australia Director, Strategic Support Section Australian Government Department of Health and Ageing Representing Palliative Care Intergovernmental Forum ADDITIONAL CONTRIBUTORS Mr Chris Forsey Assistant Director (2004) Palliative Care Section Australian Government Department of Health and Ageing Ms Jeanne Mansbridge Assistant Director (2003) Palliative Care Section Australian Government Department of Health and Ageing Ms Chris Pusell Assistant Director Strategic Support Section Australian Government Department of Health and Ageing SECRETARIAT Ms Wendy Cook Project Officer Palliative Care Section Australian Government Department of Health and Ageing Guidelines for a Palliative Approach in Residential Aged Care 229
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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
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14.5 PREPARING FOR IMMINENT DEATH
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education of the aged care team and
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Table 21: Grief, loss and bereaveme
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• excessively avoiding tasks remi
Page 191 and 192: Vignette 18: Reflections When provi
Page 193 and 194: may have been able to contribute to
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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 232 and 233: geropsychologist A geropsychologist
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 244 and 245: APPENDIX C An evaluation tool for q
Page 246 and 247: APPENDIX D An evaluation tool for q
Page 248: APPENDIX E: Summary of the stakehol
Page 251 and 252: (a) FOCUS GROUP (b) WEB FEEDBACK (c
Page 254: APPENDIX H: Useability trial — pa
Page 257 and 258: Spiritual Hermann, C.P. (2001). Spi
Page 259 and 260: ENDURING POWER OF ATTORNEY AND GUAR
Page 261 and 262: Good Palliative Care Order Form Ant
Page 263 and 264: Acceptance of Power of Attorney 1.
Page 266: APPENDIX L An example of an Ecomap
Page 269 and 270: cognitive ability 49 cognitive beha
Page 271 and 272: Mini Mental State Examination 123,
Page 274 and 275: Guidelines for a Palliative Approac
Page 276: For more information about the Nati
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Guidelines for a Palliative Approach in Residential Aged Care

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