Background:
Australian hospitals can and do provide excellent palliative care, however high-quality care in this setting cannot be assured for all who require it.
Aim:
To strengthen palliative care in an Australian hospital by supporting nurse leaders to implement pragmatic, evidence-based improvement strategies in response to inpatient and carer perceived quality of care data.
Methods:
Design: Action research.
Setting: Three wards within the Canberra Hospital (aged care, oncology, respiratory).
Participants: Patients with palliative care needs and their family members via reported experience survey data, ward nurses and nurse leaders via interviews and survey completion.
Results
Two wards have participated throughout the project (oncology and general medicine) and one ward has withdrawn (aged care). Phase 1 data included 23 patient reported surveys, 12 family surveys, 8 nurse interviews and 24 nursing survey completions.
Preliminary analysis of patient and family data identified five areas for focus: (1) Safety, comfort and dignity; (2) Communication; (3) Timeliness of care; (4) Symptom management; and (5) Emotional support. Presentation of data to a co-design workshop held with senior nursing clinicians, prioritised two areas for intervention focus: 1. Tailored information for each ward; and 2. Implementation of ‘critical questions’ by nursing team.
Intervention implementation is underway and Phase 3 data collection planned for April 2022.
Discussion
Implementing and driving change within acute care settings is complex. Translating patient and family care priorities (through reported experience measures) into actionable strategies is critical to drive the policy reforms required and enable clinicians and managers to implement best palliative care at the ward level.
Conclusion
Improving palliative care within acute care settings has remained challenging for decades. Amplifying patient and family experience of care quality can inform improvement priorities. How to do this in a sustained, pragmatic and feasible way is yet to be confirmed. Enabling this is a critical step to ensuring that collecting meaningful data, with the capacity to drive change, is achievable and acceptable to all stakeholders; and that understanding of key facilitators required by wards to support change is well understood.