Registered Nurses and Enrolled Nurses will be directly involved in providing palliative care in aged care. Their role includes:
- providing leadership and direction to care workers
- liaising with families
- coordinating service delivery from GPs, allied health, palliative care teams and acute care
- carrying out needs assessments and planning and reviewing care.
Nurses in residential aged care or home-based care may not have direct access to palliative care specialists on-site. Like many other primary care health providers, they will continue to simultaneously provide rehabilitative and supportive care to residents’ who are not dying and end-of-life care to those residents who are dying. [1]
Staffing structures and work systems in residential aged care have been designed to promote wellness, quality of life and prevention of harm in a home like environment. This means they may not have been specifically designed to support palliative care. [2]
The ability of nurses in aged care to implement effective palliative care may be influenced by many factors. Some of these are listed below:
System / organisation factors
- Staffing levels and expertise
- Management support for palliative care, education and training
- Physical structures, privacy, space for family to stay, meeting rooms for family conference
- Lack of resources to support family eg, grief and bereavement counselling
- Access to GP support and after hours pharmacy for medication changes
Knowledge / skills
- Feeling comfortable and confident in discussing death and dying and end-of-life care
- Difficulty in assessing needs of residents with cognitive impairment
- Recognising dying and knowing when to implement palliative care
- Concerns about administering analgesia
Family / resident / client
- Knowing when it may be inappropriate or difficult for family to discuss resident’s dying for cultural reasons
- The resident/client or family wanting to continue with active care that may not be beneficial
- Family not being comfortable making decisions about care or not knowing what the person would have wanted.