Providing Palliative Care in an Aged Care Facility: Addressing Patient Needs and Cultural Considerations

QUESTION

You are working in a residential  aged care facility and nursing a 74 year old client who is in the advanced stages of breast cancer – she is not expected to live longer than 6 months. She has developed a malignant wound causing both pain and strong malodour, the latter of which is particularly distressing to the client.

Answer the following questions with references to each answer

1. According to the national palliative care standards how can you ensure that your patient’s assessments of needs are being met?

2. How is the End-of-Life Directions for Aged Care dashboard (ELDAC) used to support a palliative approach in aged care?

3. The client is from a different culture and religion to your own, and you have not worked with other clients from this culture in the past.
What are 2 ways in which the client’s culture and religion may affect the care you provide to the client and his family? And what are 2 methods you might use to find out this information?

4. How can you help support the client’s nutritional status? And which specialist would you involve when doing this?

5. As the client’s condition has deteriorated, her appetite and thirst have decreased. One of the client’s family members is trying unsuccessfully to get the client to drink some water and asks you if IV therapy can be provided to help prevent the client becoming dehydrated.
What will you say to the family member?

6. As the client deteriorates, she increasingly demonstrates signs of depression.
Is this behavior a normal part of the grieving process? And how would you support the client?

7. The client is now showing signs of confusion and restlessness. What are you going to assess her for?  and provide 2 strategies to manage these symptoms.

Answer all questions with references.

ANSWER

Providing Palliative Care in an Aged Care Facility: Addressing Patient Needs and Cultural Considerations

Introduction

Caring for individuals in advanced stages of illness, such as a 74-year-old client with advanced breast cancer, requires a palliative care approach that focuses on addressing their physical, emotional, and cultural needs. This essay will address various aspects of palliative care, including meeting patient needs, utilizing the End-of-Life Directions for Aged Care dashboard (ELDAC), accommodating cultural and religious considerations, supporting nutritional status, managing symptoms, and addressing depression.

Ensuring Patient Needs Are Met According to National Palliative Care Standards

To ensure the patient’s assessments of needs are being met, the following strategies can be employed:

Holistic Assessment: Conduct a comprehensive assessment of the client’s physical, psychological, social, and spiritual needs. Utilize assessment tools recommended by the national palliative care standards, such as the Edmonton Symptom Assessment System (ESAS) or the Palliative Performance Scale (PPS). Regularly reassess the patient’s symptoms, including pain and malodour, to guide appropriate interventions.

Care Planning and Goal Setting: Collaborate with the patient, their family, and the interdisciplinary team to develop a care plan that addresses their identified needs and goals. Ensure the care plan includes regular reviews and adjustments based on the patient’s changing condition and preferences.

Reference: Palliative Care Australia. (2021). National Palliative Care Standards. Retrieved from https://palliativecare.org.au/standards

Utilizing the End-of-Life Directions for Aged Care (ELDAC) Dashboard

The ELDAC dashboard is a valuable tool that supports a palliative approach in aged care by facilitating communication, coordination, and access to resources. It can be used in the following ways:

 Information Sharing: The dashboard provides a centralized platform for sharing important information among the aged care team, including medical history, care preferences, and goals of care. This promotes continuity of care and ensures a patient-centered approach.

Decision Support: ELDAC offers evidence-based guidance and resources for complex care decisions, including managing symptoms, discussing end-of-life care options, and supporting families. It empowers healthcare professionals to provide optimal care aligned with best practices.

Reference: End of Life Directions for Aged Care. (n.d.). ELDAC Dashboard. Retrieved from https://www.eldac.com.au/eldac-dashboards

Cultural Considerations and Religious Impact on Care

When caring for a client from a different culture and religion, it is important to acknowledge and respect their beliefs and practices. Two ways culture and religion may affect care include:

Communication and Language: Cultural and religious beliefs may influence the client’s preferred language, communication styles, and decision-making processes. It is crucial to identify and address any language barriers to ensure effective communication and shared decision-making.

Rituals and Practices: Cultural and religious practices may impact dietary preferences, end-of-life rituals, and family involvement. Understanding these practices allows for tailored care that respects the client’s beliefs and values.

Methods to gather information include

i) Consulting Cultural Liaisons: Engage with cultural liaisons, interpreters, or community leaders who can provide insights into the client’s cultural background, values, and traditions.

ii) Culturally Sensitive Assessment: Use culturally sensitive assessment tools or questionnaires that inquire about cultural and religious practices and preferences. Adapt these assessments to the specific cultural context.

 Supporting Nutritional Status and Specialist Involvement

To support the client’s nutritional status, the following strategies can be implemented:

Oral Nutritional Intake: Encourage small, frequent meals with nutrient-dense foods tailored to the client’s preferences and cultural needs. Offer texture modifications, if necessary, and provide mouth care before and after meals to enhance comfort and taste.

Involvement of a Dietitian: Collaborate with a registered dietitian who specializes in palliative care. They can assess the client’s nutritional requirements, provide personalized recommendations, and address any swallowing difficulties or dietary restrictions.

Reference: Australian Government Department of Health. (2019). Palliative Care for Older Australians in Residential Aged Care Facilities. Retrieved from https://www.health.gov.au/resources/publications/palliative-care-for-older-australians-in-residential-aged-care-facilities

Addressing IV Therapy for Hydration

When a family member asks about IV therapy to prevent dehydration, it is important to have an open and honest conversation. Explain that:

IV therapy may not align with the client’s goals of care in palliative care, as it may cause discomfort, interfere with the client’s quality of life, and potentially prolong the dying process.

Emphasize alternative measures to ensure comfort and alleviate symptoms, such as gentle mouth care, ice chips, or small sips of water if tolerated.

Highlight the importance of maintaining oral hygiene and providing comfort measures to manage any potential distress associated with dry mouth.

Reference: Palliative Care Australia. (2021). Clinical Practice Guidelines for the Psychosocial Care of Adults with Cancer. Retrieved from https://www.cancer.org.au/content/legacy-dam/cancer.org.au/health-professionals/guidelines-and-standards/clinical-practice-guidelines/psychosocial-care-of-adults-with-cancer/pscoa-palliative-care-2016-pdf.html

Addressing Depression and Grieving

Depression is a common response during the grieving process, but it requires appropriate support. To address this:

Acknowledge that experiencing depression is a normal part of the grieving process, which can be complex and multifaceted.

Provide emotional support, active listening, and empathetic communication to create a safe space for the client to express their emotions and concerns.

Involve a mental health professional, such as a psychologist or counselor experienced in palliative care, who can provide specialized support and interventions for depression.

Reference: Australian Government Department of Health. (2021). Mental Health Care for Older Australians. Retrieved from https://www.health.gov.au/resources/publications/mental-health-care-for-older-australians

Assessing and Managing Confusion and Restlessness

To assess the client’s confusion and restlessness, consider the following steps:

Conduct a thorough physical and cognitive assessment to identify any underlying medical conditions, such as infection, metabolic disturbances, or medication side effects, that may contribute to the symptoms.

Use validated assessment tools, such as the Confusion Assessment Method (CAM) or the Delirium Observation Screening Scale (DOSS), to assess the severity and characteristics of confusion and restlessness.

Strategies to manage these symptoms include

Environmental Modifications: Create a calm, soothing, and familiar environment for the client. Minimize noise, provide adequate lighting, and maintain a regular routine to promote a sense of security.

Medication Review and Collaborative Care: Collaborate with a geriatrician or palliative care physician to review the client’s medication regimen and consider adjustments or discontinuation of medications that may contribute to confusion or restlessness.

Reference: Australian Government Department of Health. (2020). Delirium Clinical Care Standard. Retrieved from https://www.safetyandquality.gov.au/sites/default/files/2020-08/delirium-clinical-care-standard_1.pdf

Conclusion

Caring for individuals in the advanced stages of illness requires a comprehensive palliative care approach that addresses physical, emotional, and cultural needs. By adhering to national palliative care standards, utilizing tools like the ELDAC dashboard, considering cultural and religious influences, involving specialists, and employing appropriate symptom management strategies, healthcare professionals can provide holistic and person-centered care to support patients and their families in residential aged care facilities.