Enhancing palliative care at home: a generalist community nursing case study

Abstract

Objective: This quality improvement project aimed to explore the experience of home care nurse managers implementing a general palliative approach to care. Implementation comprised several interlinking activities encompassing stakeholder engagement and an education program in the outer eastern region of a home care and nursing organisation in Melbourne, Australia, between September 2019 and December 2020.Background: High quality provision of communitybased palliative and end-of-life care means people are much more likely to die at home, supported by family, friends and services. To achieve this, care staff must be adequately trained and supported, alongside a collaborative approach with other generalist and specialist providers. Study design and methods:This Case Study reports on the participant perspectives of the stakeholder engagement and education program. Focus groups and an interview were used to elucidate the experience of nursing and allied health professionals providing a general palliative approach in the community. The 2006 National Institute of Clinical Studies framework to identify barriers to best practice healthcare guided the development of focus group questions and the deductive analysis of data.Results: Seven Nursing Care Managers and one Social Worker participated in two online focus groups and one interview. Three overarching themes highlighted the value of tailored education in increasing staff knowledge and confidence, the factors for a successful generalist-specialist partnership, and the unique nature of the home care setting which requires accessible systems and processes.Discussion: This project supports assertions that generalist services can play a valuable role when a palliative approach to care is incorporated. It also underscores the importance of collaborative working partnerships between generalist and specialist services in providing quality community-based palliative care. Future research should examine the needs and perspective of clients, carers and families receiving a general palliative care approach in the community. Implications for research, policy and practice:Investment in developing the capacity and capability of generalist service staff to deliver palliative care AUTHORS GEORGINA JOHNSTONE BA/BSc BSc(Hons)(Psych) 1

The differences between palliative care and hospice care

“…The goal isn't to treat liver disease but to keep the patient comfortable by treating the symptoms of shortness of breath and nausea. Their goal may be to die at home in their own bed surrounded by family and friends 12. When I worked in oncology and patients were electing to go into hospice care, if the patient wanted a pizza (even if they were on a low-sodium and low-fat diet), we'd get them a pizza.…”