\Behind the blue door\" : developing the practices of aged care staff around a palliative approach in a dementia special care unit"
thesisposted on 2023-05-27, 14:25 authored by Sharon AndrewsSharon Andrews
The adoption of a palliative approach to the care within Australian Residential Aged Care Facilities (RACFs) has been supported by a range of policy and best-practice initiatives. There is a considerable body of evidence demonstrating that most people who live in RACFs are highly dependent, are likely to have dementia and will die in these locations. Dementia is recognised to be a terminal condition, further underscoring the need for appropriate and timely care. However, issues of equity and quality of palliative care for people with dementia have raised concerns about the capacity of RACFs to deliver a palliative approach to care. Therefore, this research located within a RACF in Tasmania, Australia, sought to address the question: what are the possibilities for aged care staff to develop their practices around a palliative approach to care for people with dementia and their family caregivers? The study employed a critical action research method wherein, nursing and care staff members (n=5) from a dementia special care unit (SCU) formed an action research group (ARG). With a desire to explore and improve their palliative care practices, the ARG members engaged in a critical change agenda over an 18 month period. In Stage One of the study, a preliminary investigation collected baseline from ARG meetings (n=11), staff questionnaires (n=37), interviews with family caregivers of residents from the SCU (n=10), stakeholders dialogues (n=6); and an audit of resident files (n=21). Through their critical reflection on the baseline findings, the ARG members identified three areas of practice in need of improvement these being, i) staff knowledge of a palliative approach, (ii) family caregivers' access to information and, (iii) evidence-based strategies for pain management and palliative care planning. During Stage Two, the ARG members continued to meet (n=7) as co-researchers and developed four action plans to address these concerns. During this process they shared an emerging sense of empowerment as they imagined possibilities for change. In Stage Three, the group members implemented their action plans through five successive action cycles and met (n=9) to critically reflect on the outcomes. This study illustrates that a complexity of competing economic, sociopolitical and cultural interests shape the possibilities for aged care staff to reconfigure their practices to support a palliative approach to care. It is imperative to provide opportunities for staff to engage in critical, collaborative dialogue as a means to exposing the taken-for-granted understandings that constrain innovation.
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