Self Directed Learning Package - University of Queensland

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120 • The Palliative Approach ToolkitWhy is a palliative approach important?A palliative approach can:• reduce distress for residents and their families• reduce transfers to hospital because aged care staff developskills to manage the palliative care needs of residents• help to involve the resident and their family in decisionmaking about their care• encourage open and early discussion about death and dyingwhich helps advance care planning• provide opportunities for improved control of pain and othersymptoms• allow the resident to be cared for by staff that they know andhave developed a rapport with.Bob has chronic obstructive airways disease (COAD)/emphysema that is worsening. He has already been admitted tohospital once and has said he doesn’t want this to happen again.A palliative approach aims to reduce his suffering throughearly identification, assessment and treatment of pain, physical,cultural, psychological, social and spiritual needs.Bob needs review of his symptoms particularly his shortness ofbreath. He also has some psychological and social needs thatrequire discussion with his GP, the nursing staff and his wife.Thinking PointSo it seems that a palliative approach is appropriatefor Bob. Would any of your current residents benefitfrom a palliative approach?Thinking PointIn the DVD, Bob’s careworker, Kerrie, mentions anumber of these important benefits. Can you relatethese points to the care of residents in your ownfacility?• When has open and early discussion on death anddying facilitated a good death for a resident?• Has a dying resident been transferred to hospitalunnecessarily?• How did this transfer affect the resident, family andstaff?When does a resident need a palliative approach?Watching the DVD, you would have heard that a palliativeapproach is not limited to the last weeks or days of life.It is a philosophy of care that may be appropriate many monthsbefore a resident actually dies and aims to improve the qualityof-lifefor people with an eventually fatal condition and theirfamilies.Thinking PointDo you agree that Bob needs a palliative approachto his care? He has been in the facility for over 12months. Why do you think it is only now beingdiscussed?Specialist palliative careIn the DVD, Peter, the GP suggested getting a specialist palliativecare team to help plan for and treat Bob’s severe breathlessness.A small number of residents may experience severe or complexproblems as their condition advances. These may be physicalsymptoms or complex ethical dilemmas, family issues orpsychological distress.Specialist palliative care teams do not usually take over the careof residents but instead can provide advice on complex issuesand support to GPs and the aged care team.Terminal careWhereas palliative care may take place over many months,terminal care is the care focused on the final days orweeks of life.This form of palliative care is appropriate when the resident isin the final days or weeks of life and care decisions may need tobe reviewed more frequently. Goals are more sharply focusedon the resident’s physical, emotional and spiritual comfort andsupport for the family, including bereavement care.Identifying when a resident is moving into the terminal phase isnot easy because there are few clear indicators to identify whena person should be considered for end of life care. (You will readabout this in more detail later in this package).
121 • Self Directed Learning Package - CareworkerAdvance careplanningKey PointEveryone should have the opportunity to expresstheir wishes about the treatment and care that theyreceive.Advances in medical technology have allowed people to survivelonger despite many chronic illnesses. It is good news that manyof us will live to a very old age, but people often survive withlots of problems. We now have the technology to keep peoplealive artificially, where in the past, they may have died naturally. 7Thinking PointThe tough question is just how much invasive oragressive medical attention is a good thing. The bestanswer is that it is up to everyone as individuals todecide for themselves. Have you thought about:• What constitutes quality-of-life for you?• What types of invasive medical procedures do youconsider to be undesirable?• If you had multiple physical problems, at whatpoint, would you want the doctors to stop trying toprolong your life?• What are your values and beliefs (religious, spiritualor otherwise)?• When your time eventually comes, what wouldconstitute a ‘good death’ for you? 7Most people never speak about these issues. When peopleare critically ill, they are usually unable to participate in theseimportant decisions. 7
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Self Directed Learning Package - University of Queensland

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