Dr Priyanka Vandersman1, Professor Jennifer Tieman1
1Flinders University [ELDAC Project], Australia
Biography:
Priyanka is a Registered Nurse and digital health technology researcher. She is a Senior Research Fellow at the Research Centre for Palliative Care, Death and Dying [RePaDD], and works with the End of Life Directions in Aged Care [ELDAC] Project's Flinders University team. Her work focuses on building the capability of the Australian aged care sector in providing quality end of life care using novel approaches. She is particularly interested in developing, implementing, and evaluating novel digital technologies to support end of live care giving processes.
Abstract:
Background: The Residential Aged Care [RAC] sector provides care to a significant number of older people across frail and vulnerable years, all the way through to the point of death. As such, palliative care, and considerations for end-of-life caring need to be considered core aspects of aged care practice in Australia.
Aim: To explore how residential aged care nurses understand, describe, and provide care to people who are in the last year of life.
Methods: Qualitative study involving focus groups and interviews with RAC nurses working in Australia. Data collection was carried out via video conferencing software and telephone and managed using the NVivo software. Thematic analysis approach was used for data analysis.
Results: Seventy participants from 14 RAC services across three Australian States took part in 11 focus groups and six semi-structured interviews. Half of the services (n=7) were located outside metropolitan areas, with two services focusing on care for Aboriginal and Torres Strait Islander People.
Four key themes emerged from the qualitative data:
Unique caring needs in the last 6-12 months of life.
Triggers to identify this stage may not always be obvious.
Care provision is task-oriented and influenced by nursing hierarchy.
Despite intentions for good care, barriers persist.
Participants highlighted differences in the needs of older people experiencing gradual decline versus those in the terminal stage. Early discussions about death with families and residents were deemed valuable, but resource constraints limited the opportunities of quality one-on-one care.
Conclusions: In RAC settings, nurses recognize the importance of recognising early health decline and identifying residents nearing end of life, but workflow and resource limitations hinder their ability to engage effectively. Developing and implementing resources and processes to enable nurses to identify early decline and deliver timely, quality end-of-life care is imperative.