Start with what is needed to have an impact

A blog post written by Dr. Katrina Erny-Albrecht

Dying has and always will be core business for aged care. Death and older age go hand in hand. For many this stage of life requires support from others to address pain management, emotional distress and clinical needs related to life-limiting chronic illness. The aim of palliative care is to alleviate suffering and allow people to focus on what matters to them as they approach the end of life. At its core is a focus on quality of life. Achieving this requires a mix of social and clinical support. A very broad remit that is provided by the aged care workforce every day. Yet, even before the COVID-19 pandemic the aged care sector faced high rates of staff turnover, increasing demand for aged care and palliative care services, and a dedicated workforce with insufficient or highly variable training. A little over twelve months ago, this led to a conversation between sector members and the CareSearch/palliAGED team about what was really needed.

Fast forwarding six months to May 2021 we come to the release of the palliAGED Introductory modules in palliative care, a 10-module suite of practical advice developed in response to that series of conversations. The CareSearch/palliAGED team understood that creating a resource or making information available is not of itself enough. People need to be aware that it exists and what to do with it. Optimally, it should respond to an identified need and be available in formats that are fit for purpose. The modules are an entry point for practical learning that introduces the core concepts of palliative care with a door to learning more. Armed with sector insights about specific topics and areas of need, we set about extending the utility of the popular evidence-based palliAGED Practice Tip Sheets for Nurses and Careworkers. The Tip Sheets had been developed in response to sector needs and considerations, and with an emphasis on ‘what you can do’, so the two resources work together. They also provide a natural progression to other materials in the palliAGED practice and evidence centres.

Six months after release of the modules, we are starting to see their impact. In that short period more than 35,000 modules have been completed. Voluntary feedback forms designed to identify areas for improvement have been completed by approximately 1,000 users per module. Four in ten respondents reported that they felt confident in all aspects of palliative care.  Yet those same confident providers of care valued the modules as a reminder of core concepts and the importance of engaging with the person and then the task. The responses also told us that one in ten respondents felt that they needed to focus their learning across all aspects of palliative care. Bereavement, support of families, and communications were all identified as areas of need.

Aged care providers have told us that the flexibility to choose individual modules for different staff groups has been important. Nurses, careworkers, and support staff from administration to kitchen and maintenance workers were invited to step through selected modules. Sometimes it is the unscheduled observations that tell us how well a person is or isn’t managing. Knowing the signs and what to say helps everyone to play their part. In addition to this almost 30 organisations have asked to host the palliAGED modules on their local learning management system. palliAGED has offered this option because we understand that provider arrangements and staff access to external technology platforms vary.

To receive responses such as ‘I will now better document the signs so that change is tracked’, ‘I will look for signs of frailty’, ‘I will try to get the doctor more involved with the family’, or ‘I will be more forthcoming with my reporting’ suggests there is impact. Comments such as ‘this will change how I approach palliative care residents and I will attend to their care with compassion and dignity’ tells us it will likely make a difference. If the contribution of palliAGED supports high quality care and encourages carers to reach out for more education, then we are making progress. Like many things in life, palliative care takes a village. Recent establishment of the Aged Care Council of Elders and the Aged Care Advisory Council aims to give voice on aged care matters to senior Australians and aged care experts respectively. For many older Australians the aged care workforce is an essential part of their village. As outlined here, listening and responding to their experiences and needs can also have a positive and real impact that benefits everyone.