Self Directed Learning Package - University of Queensland

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140 • The Palliative Approach ToolkitMyths about opioidsOpioids (e.g. morphine, oxycodone or fentanyl) area type of strong analgesic.Sometimes residents, family members and even agedcare staff may have concerns about these medications.It is important to know that, when used correctly,opioid medicines:Do not lead to addiction or dependenceOpioid medicines are not addictive when used for pain.Addiction only occurs when people have no pain andthey abuse opioid medicines.Do not hasten deathMorphine and other opioid medicines are for improvinglife – not hastening death. Some people fear that beingprescribed opioid medicines means that they’re closer tothe end. However, relieving pain changes the quality-oflife– not its length.Do not cause terrible side-effectsAll medicines can have side effects. The side effects ofopioid medicines (constipation, drowsiness, nausea, drymouth) are usually manageable.WriteDocument your actionsMany residential aged care facilities expect careworkersto document information on assessment charts and inthe clinical record.Avoid general statementsPOOR COMMUNICATIONGOOD COMMUNICATIONEvaluation of interventions for pain ‘with ‘Resident states pain has reduced to 2/10effect’ or ‘effective’.score (was 5/10)’.ReviewEvaluate and reassess as necessaryThinking PointYou identified that Alfred has pain. You helped himstraighten up in bed, massaged the painful area (asdirected in the care plan) and asked the nurse aboutsome analgesic medication. Great job! Can you tickthis off your list? Not quite yet. There is an importantquestion to answer: Did your strategies work?You can check the effectiveness of your management strategiesby asking the resident to rate the severity of their pain again(using a rating scale), observing their behaviours or facialexpression, or asking if their mood, sleep or function hasimproved.Key PointOnce you review and reassess a resident it is veryimportant that you pass this information on to anurse (and document your assessment if this is partof your role as a careworker).
141 • Self Directed Learning Package - CareworkerNutrition andhydrationOne of the big worries that Alfred’s daughter, Sarah, had at thepalliative care case conference was that Alfred might starve todeath if he is unable to eat and drink. Remember that Sarah’smother was fed through a gastrostomy tube after she hada stroke. This continued for three weeks before she died ofpneumonia.SeeRecognise and assessAlfred is drowsy and needs prompting to accept a drink from acup and straw.He only eats a few mouthfuls of food and sometimes coughswhen he swallows. Alfred is dying and this is causing his eatingand drinking problems. This is often a difficult and emotionaltime for families and can sometimes be hard for staff to manage.Key PointAt the end of life the body is beginning to shutdown because of the dying process, not because ofthe absence of food and fluids.Family members often find it difficult to distinguishbetween ‘not eating as part of the dying process’and ‘not eating as bringing about the dyingprocess’.Helping families understandThe PA toolkit contains a brochure “Understanding the DyingProcess” which can be given to family members when theresident is in the palliative or terminal phase.Table 3 provides a brief segment from the “Understandingthe Dying Process” brochure. This brochure is included inthe PA Toolkit and we recommend you familiarise yourselfwith the document.Table 3Segment from “Understanding the Dying Process” brochureMost people lose their appetite in the last few weeks of life.This is a very natural and normal part of the dying processbecause metabolism is slowing down and the body requiresless nutrition.At this time your instincts may be to try and feed the personin order to keep up their strength. The giving of food is oftensymbolic of loving and nurturing and to deprive someone ofthis may feel like neglect. However, as the person becomesincreasingly weak and drowsy, swallowing and digesting food andfluids often becomes harder and can place strain upon the body.Whilst the person may have a reduced oral intake, it is importantto maintain good oral care. Regular moistening of the mouthand lips will add to the person’s comfort.SayReport your assessmentAs a careworker you play a critical role in reportingresident’s symptoms to the nurse.Thinking PointConsider the following scenario:Alfred cannot feed himself now. When you help tofeed him, you notice he falls asleep whilst chewingand sometimes coughs.How would you report this to the nurse?
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