Guidelines for a Palliative Approach in Residential Aged Care

palliative care teams is more appropriate for RACFs, alternate models and approaches about
how to create a palliative approach or access palliative care expertise for different RACFs is
likely to be the best approach.
One approach is the creation of a palliative nurse practitioner role in RACFs [55] (Level QE).
A palliative nurse practitioner is a suitably qualified RN experienced at an advanced level
who provides a leadership role and coordinates clinical consultation and care to residents of
RACFs, their families and members of the palliative team. [55] In one study, a ‘link nurse’ was
also established to facilitate continuity of care in the RACF. A link nurse was defined as a nurse
who is interested in, has received training in, and pursues continuous education in a palliative
approach. [55] This nurse is not expected to be an expert in a palliative approach, but understands
the philosophies and practices of palliative care, and will promote and facilitate the care of
residents in the RACF to ensure an appropriate palliative approach is provided. In the study
referred to, an evaluation of the service at six months indicated that 17 residents that previously
would have been transferred to an acute care facility were able to die at the RACF. [55]
Despite variations in RACFs, Maddocks and colleagues (1999) [55] recommend that, at the
minimum, one member of the aged care team (preferably an RN) should have some formal
qualification in a palliative approach. This level of training and expertise would also assist
the aged care team ensure staff receive adequate direction and supervision and that accurate
symptom assessment, using validated assessment tools, occurs (see also Section 6.1, ‘Symptom
assessment’). Ideally, all aged care teams in RACFs should have sufficient training to apply the
sensitive interpersonal communication required for a palliative approach that improves the level
of satisfaction of residents and their families [44] (Level III-2).
Guideline:
Who can provide a palliative approach?
Ref No.
Evidence level
4. A palliative approach is best provided by an effective
multidisciplinary team.
50 III-2
Guidelines for a Palliative Approach in Residential Aged Care 45