Guidelines for a Palliative Approach in Residential Aged Care

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9. Indigenous support, 10. cultural support, 11. advance care plans, 12. dignity and quality of life, and 13. rural and remote issues. 1.1.3 Search Strategies Preliminary work in searching showed that two search strategies would be necessary to capture all the relevant literature for the development of evidence-based practice Guidelines. The first sweep of the literature aimed to acquire relevant studies (both quantitative and qualitative) using the above outlined domains. This top-down approach elicited articles covering a broad range of issues. The second strategy used specific terms that emerged from articles found during the first search strategy. This refinement addressed the specific issues found in caring for older institutionalised persons with life-limiting conditions (e.g. Cachexia in terminal illness), or who were dying as a consequence of the process of ageing. The literature was searched electronically for English language articles published in peer-review journals from 1990 to Week 3 September 2002 using the first search strategy. Additional electronic searches using the second strategy covered the period 1990 to Week 4 September 2003. (Further searches were required due to stakeholder feedback that recommended additional issues should have been included, such as post-bereavement support for family and friends, continuity of care, complementary therapies, and privacy and confidentiality). Both search strategies were conducted on databases MEDLINE, CINAHL, EMbase, Cochrane Library and Current Contents, APAIS, DRUG, PsychINFO, and Dissertation Abstracts International. (See Table 1 for search terms). Relevant secondary references were included in the review. Searches also included a hard copy search of books and publications at Flinders University libraries (Sturt, Medical and Central) and Repatriation General Hospital libraries (Daw House and Medical) between July 2002 and September 2003. Searches on the World Wide Web for government and non-government publications, standards of care, existing guidelines and reports to government were also conducted between August 2002 and September 2003. Guidelines for a Palliative Approach in Residential Aged Care 17
Table 1: Search terms Terms Aboriginal Advance Care Planning Aged care Assessment tools Australian Bereavement Breast Cancer Cancer Care Givers Cardiac Care Clinical Complementary therapy Cultural Dementia Depression Education Hospital Nonclinical staff Nonprofessional staff Neurological New Zealand Nursing Occupational Therapy Pain Words or variations of words that were used in searches Aboriginal; Indigenous; koori Advance directive/s; advance care plan/s/ning; decision making; end-oflife care; legislation; Aged care facility/ies; gerontological care; group homes; homes for the aged; residential facility/ies; residential care; residential aged care facility/ies; RACF; halfway houses; health services for the aged; high level care; long term care; long stay homes; nursing homes; hostels Symptom assessment; tools; indicators; instruments Australia/n; Royal College of Nursing, Australia bereavement; grie/f/ve/ving; death and dying; hospice; death rit/e/s/ual/ s; occupational stress; staff stress; hospital programs; memorial service; life experiences; rit/e/s/ual/s (nonreligious); symboli/c/sm; ritual referral; unresolved grief; complicated grief; at-risk population/s; treatment/s; psychopatholog/y/ies; pathological grie/f/ving; coping behaviour/s Neoplasms; cancer; malignanc/y/ies; oncology Famil/y/ies; care givers heart Evidence; random/ised/ized controlled trials; guideline/s; Complementary therap/y/ies; alternative therap/y/ies Multicultural; culture/al; diversity; cultural diversity Dementia care; cognitive impairment Depress/ed/ion/ing; clinical depression Train/ing; educat/e/ion/ing; skill/s/ed; staff development; in-service training; Hospitals — special; teaching; urban; rural/remote; acute care setting/s Maintenance staff; non-clinical staff; cleaner/s/ing; gardener/s/ing; care team/s Domestic; non-professional/s; ancillary; uneducated; volunteer/s/ing/ ism; nurses’ aides; aides; personal care assistants; nurses’ assistants; unregistered; care assistants Neurologic/al New Zealand; NZ Nursing role/s; terminal car/e/ing; end-of-life care; quality of nursing car/e/ing; registered nurse/s; Registration/s Occupational therap/y/ies/ist; OT Pain/s; pain management; pain assessment 18 Guidelines for a Palliative Approach in Residential Aged Care
Page 1 and 2: Guidelines for a Palliative Approac
Page 3 and 4: NHMRC APPROVAL These guidelines wer
Page 5 and 6: 4 ADVANCE CARE PLANNING 55 4.1 Impl
Page 7 and 8: 16 MANAGEMENT’S ROLE IN IMPLEMENT
Page 9 and 10: 17 Ann and Mr Wells’ family Helpi
Page 12: IMPORTANT NOTICE On 8 December 2005
Page 15 and 16: achieved for these guidelines from
Page 17 and 18: facets of a palliative approach are
Page 19 and 20: Additional levels of evidence The N
Page 21 and 22: Guidelines Ref No. Evidence level A
Page 23 and 24: Guidelines Ref No. Evidence Cachexi
Page 25 and 26: Guidelines Ref No. Evidence Anxiety
Page 27 and 28: Guidelines Ref No. Evidence 70. Und
Page 29: 1.1.1 Aims The aims of the systemat
Page 33 and 34: 1.1.5 Exclusion Criteria Although t
Page 35 and 36: in the methodology that may invalid
Page 37 and 38: To ensure the reliability of the re
Page 39 and 40: 1.2.2 Methodology When the first re
Page 41 and 42: 1.4.2 Method When feedback was requ
Page 43 and 44: Several Working Party members conve
Page 45 and 46: or disagreed with each stakeholder
Page 47 and 48: All the feedback received was colla
Page 50 and 51: CHAPTER 2 A PALLIATIVE APPROACH A s
Page 52 and 53: • Profound weakness • Trouble s
Page 54 and 55: • Has the resident had a recent d
Page 56 and 57: in the RACF rather than transferrin
Page 58: palliative care teams is more appro
Page 61 and 62: or ageing progression (see Table 4)
Page 63 and 64: Table 7: A practical model of socia
Page 65 and 66: Vignette 2: Robert’s story Robert
Page 68 and 69: CHAPTER 4 ADVANCE CARE PLANNING Car
Page 70 and 71: efore discussing the advance care p
Page 72 and 73: • A change in their health status
Page 74 and 75: CHAPTER 5 ADVANCED DEMENTIA Advance
Page 76 and 77: A study was conducted to investigat
Page 78 and 79: 5.3.2 Acute illness One study found
Page 80:
Vignette 5: Anna’s story Anna was
Page 83 and 84:
(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
Page 189 and 190:
• excessively avoiding tasks remi
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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
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REFERENCES 1. World Health Organiza
Page 200 and 201:
31. Hanson, L. C., Danis, M. & Garr
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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
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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
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295. Brown, T. M. & Boyle, M. F. (2
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328. Kristjanson, L. J., Leis, A.,
Page 222 and 223:
360. McGrath, P., Vun, M. & McLeod,
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392. Saunders, C. M. & Baines, M. J
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424. Rawlings, D. & Glynn, T. (2002
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Glossary acetaminophen Acetaminophe
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coordinator of volunteers coping A
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geropsychologist A geropsychologist
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opioids Opioid is a specific term u
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specialised palliative team A speci
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Ms Wendy Shiels Dr Jane Sims Dr Chr
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APPENDIX B The Australian Governmen
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APRAC GUIDELINES: EVIDENCE EVALUATI
Page 247 and 248:
APRAC GUIDELINES: EVIDENCE EVALUATI
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APPENDIX F: Summary of the frequenc
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APPENDIX G: An example of how the g
Page 256 and 257:
APPENDIX I: Resource list PALLIATIV
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Psychological Challenge Depression
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APPENDIX J: Examples of advance dir
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Schedule 1 MEDICAL POWER OF ATTORNE
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APPENDIX K An example of a Genogram
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INDEX Abbey Pain Scale 64, 71, 78 A
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evidence levels 5, 6, 20, 21, 22 ev
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andomized controlled trials 5, 21 R
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Palliative Care Australia PO Box 24
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