Collaborative Strategies in Palliative Care for Aged Care Residents

Introduction:

To deliver high-quality palliative care to aged people at residential aged care facilities, nurses need to analyse the evidence critically, implement patient-centred approaches and cooperate with various health workers to enable interdisciplinary collaboration (Johansen & Helgesen, 2021). At Western Sydney Nursing Home (WSNH), several residents suffer from severe diseases that require palliative care to provide the patient with comfort and improve their quality of life ensuring comfort and dignity.  Nursing staff, who are at the core of aged care provision have to ensure both the residents and their families are educated in a way that is both medically safe and emotionally and ethically supportive. This paper investigates why effective team collaboration in multi-disciplinary Teams is crucial for providing coordinated care and the strategies used to ensure families and carers of palliative residents are involved in the care plan, based on the latest research, ACQS and NMBA guidelines.

Collaboration and Teamwork in Coordinated Person-Centered Care for Palliative Care:

According to Ludlow et al. (2021), to ensure the quality deliverance of palliative care for the residents in an aged care facility, MDT's teamwork and collaboration are seminal. Along with managing patients' symptoms, palliative care aims to facilitate the seamless management of patients' psychological, emotional, cultural and spiritual needs. This type of holistic care works only when all the professionals in the multi-disciplinary team coordinate their actions within professional boundaries.

In most aged care facilities, including WSNH, the MDT includes registered nurses, enrolled nurses, general practitioners, physiotherapists, occupational therapists, dietitians, palliative care specialists, chaplains and social workers. With each having their unique expertise the team's combined efforts enable the formation of a detailed plan that can cater to the patient’s changing illness (Bareham, 2022).

Harasym et al. (2021), has reinforced the significance of interdisciplinary collaboration stating that the combined effort of multi-disciplinary teams ensures effective palliative care. Lammila-Escalera, et al. (2022) discovered that MDTs lead to better care coordination by reducing care fragmentation, mitigating the possibility of errors and adverse events, and ensuring that residents live better by providing them with required interventions promptly. For example, in a situation of breakthrough pain, a nurse can right away contact the doctor for prescription options whereas the physiotherapist may use non-pharmacological techniques to reduce discomfort.

This collaboration is dependent on the principles of person-centred care from the ACQS Standard 1: Consumer Dignity and Choice, which states that the care is feasible when professionals share their knowledge of the resident’s needs, respecting their autonomy and preferences (Aged Care Quality and Safety Commission, 2023). Having interdisciplinary rounds and case conferences ensures that everyone works together facilitating shared decision-making while taking the and hearing the input from both the resident and family members also.

Additionally, the NMBA Code of Conduct (2018), for nurses in New South Wales highlights the importance of partnership with other health professionals to ensure safe, evidence-based and patient-centered care. Oftentimes, residents and their families primarily contact nurses to communicate their concerns, wants and needs, so the MDT can plan and set goals together. In certain situations, such as when a resident wishes to remain in their room during the end of their life care, the entire MDT can collaborate and discuss setting up the appropriate equipment, allocate staff members and prepare for symptom management, all ahead of time.

Because the conditions of the patient can change rapidly, person-centred care has to be reassessed all the time. Continuous interdisciplinary collaboration is the key to ensuring the dynamic process. Tran et al. (2022) say that MDTs who check on the resident's condition regularly can provide better care as they are equipped with the information regarding the resident's values and stage of illness and hence can adapt to care plans accordingly.

Overall, MDTs ensure that palliative care is more collaborative, empathic, responsive and ready to adapt. Implementing a person-centred approach addresses the physical, emotional and social aspects of end-of-life care which leads to a better quality of life for the resident and provides their families confidence that the needs of their loved one’s needs are being holistically managed.

Critical Analysis of the Strategies the Nurses use to Deliver Palliative Care:

Educational support and Symptom Management:

Educating how to manage symptoms of the patient is a pivotal strategy implemented by the nurses to enhance the ability of families and carers to care for their loved ones and feel empowered in their caregiving roles (Li et al., 2021). According to Regnard & Dean (2022), they must be taught to recognise the warning signs of deterioration, manage drug plans and symptoms of pain, breathlessness fatigue etc. However, it is crucial that this learning should be backed by evidence, accessible to everyone and adjusted according to the family’s emotional state and level of health awareness.

The researchers have highlighted that caring for a family member with a serious illness often prevents carers from retaining complicated medical information. Thus, nurses should implement strategies such as the teach-back technique, visual aids and written materials (Noordman et al., 2022). Understanding is guaranteed if the information is repeated during reinforcement. There are programs such as ‘Safe Home Care’, which provides structured step-by-step guidance on how to manage symptoms and has resulted in carers feeling more confident, reducing their emergency hospital visits (Sama et al., 2024).

Emotional and Psychological Support:

Rait et al. (2021) state that during of palliative care, families typically experience intense emotional strain, anxiety about the future and feelings of anticipation, grief, helplessness and guilt as not being able to do much. Recognizing this distress and managing these concerns are the main responsibility of the nurse. In these circumstances where informal emotional care and empathy can come from anyone, incorporating ad-hoc methods can potentially overlook the families who need to be catered to psychologically on a deeper level thus there are validated tools and systematic strategies. Researchers such as advocate for the standard use of assessment tools, including the Carer Support Needs Assessment Tool (CSNAT), to recognise the support requirement of the patient effectively (Norinder et al., 2023).  Such that immediate interventions are done and timely counselling or referral to a social work service is ensured. If nurses act proactively to support emotional needs after a loss, but can help the family with preventing complex grief disorders post-bereavement.

Involvement in Decision-Making and Advance Care Planning

Lall et al. (2021), state that engaging with families for care decisions facilitates the centring of trust and transparency in person-centred care. Nurses enable such engagement by educating families about the resident condition, prognosis, and options for care. However, in some cases, tensions may arise when a family’s wishes are in conflict with what the patient had previously stated regarding their preferences or advanced care options.

According to Principle 2 outlined by Nursing and Midwifery Board of Australia (2017), nurses are required to prioritise residents’ freedom, autonomy and values and skillfully mediate in such circumstances. Additionally, through Respecting Choices framework provides a framework for value-based discussions that provide clear goals of care reducing the family conflict. In such situations, it is important to be aware of culture, and family hierarchies as to who makes the decisions since the concept of autonomy varies differently in different cultures.