Guidelines for a Palliative Approach in Residential Aged Care

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APPENDIX F: Summary of the frequency with which stakeholder groups participated in the guideline refinement process Employment category Aged Care (Group Submission) Focus group(a) #1 web feedback(b) Useability trial(c) Newspaper feedback(d) #2 web feedback(e) Total number - 4 - 2 6 12 Aged Care Representative 8 2 - - 2 13 Care Assistant 3 - 10 - - 13 Chaplain / Pastoral Care Worker 5 1 2 1 2 11 Clinical Nurse Consultant 14 1 - - 3 18 Complementary Therapist 4 - - - - 4 Consumer 4 3 - - 1 8 Coordinator of Volunteers 8 2 1 - 4 15 Dementia Consultant 3 - - - 1 4 Director of Nursing / Care Manager 42 21 3 - 11 77 Diversional Therapist 2 - 2 - - 4 Domiciliary Care Nurses 2 - - - - 2 Educator / Trainer 4 1 - 1 1 7 Enrolled Nurses 4 - 6 - 1 11 Executive Officer / Senior Administrator 14 3 1 3 1 22 General Practitioner 7 1 - - - 8 Geriatrician - 1 - - - 1 Government Department Representative 8 2 - - - 10 Medical Practitioner 10 1 - - 2 13 Multicultural Specific Service 3 1 - - - 4 Nurse Educator 4 - - 1 - 5 Nutrition Consultant - - - - 2 2 Peak Body (Group Submission) - 3 - 1 1 5 Peak Body Representative 5 1 - - 5 11 Policy / Project Officer 6 2 - - 2 10 Registered Nurse 12 2 9 1 4 28 Registered Training Organisation - - - - 5 5 Volunteer 4 - 2 - - 6 Wound Care Consultant - 1 - - 1 2 Not Specified - 1 - 2 3 6 TOTAL: 176 55 36 12 58 337 Guidelines for a Palliative Approach in Residential Aged Care 237
(a) FOCUS GROUP (b) WEB FEEDBACK (c) USEABILITY TRIAL (d) NEWSPAPER FEEDBACK (e) #2 WEB FEEDBACK Face-to-face meetings with stakeholder groups were conducted in all states and territories. Rural and Remote stakeholder participation was obtained via teleconferences. Responses that were received from stakeholders when the Guidelines were first posted on the Project’s Website. Three RACFs were specifically chosen to include facilities from metropolitan or rural and remote areas and which offered either high or low care and ageing in place. As part of the NHMRC approval process, the APRAC Project team was required to advise the public of the availability of the Guidelines and to request their feedback on this document. Responses that were received from stakeholders when the Guidelines were posted on the Project’s Website for the second and final time. 238 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
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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
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Vignette 18: Reflections When provi
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may have been able to contribute to
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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 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 242: APPENDIX B The Australian Governmen
Page 245 and 246: APRAC GUIDELINES: EVIDENCE EVALUATI
Page 247 and 248: APRAC GUIDELINES: EVIDENCE EVALUATI
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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