Background
There is growing urgency to improve the quality of care for people in the last year of their life within residential aged care facilities (RACFs), including the integration of a palliative approach. The Needs Rounds were introduced to integrate a specialist palliative care perspective into RACFs, assist RACF staff to identify and prioritise palliative care needs, and undertake advanced care planning for people most at risk of dying within months who had inadequately controlled symptoms and no plan of care.
Aim
To understand residential aged care facility (RACF) staff perspectives on the impact of the Palliative Care Needs Rounds on the care of their residents.
Methods
This study used an emergent qualitative design, using procedural direction from grounded theory research. Participants were recruited to via purposive and snowball sampling. Directors of Nursing at 15 Sydney RACFs were sent a written invitation via e-mail seeking permission for staff to participate in semi-structured interviews. Staff who had referred a resident to a Needs Round and/or had attended a Needs Round were then invited to participate by two Nurse Practitioners (NPs) involved in the Needs Rounds at each RACF.
Results
Participants (n= 21) were predominately registered nurses working across 11 RACFs, and almost half (47%) were managers. Interview feedback from staff highlighted five key benefits of the program. These themes were identified as: 1) Increased nursing competence in identifying residents in need of palliative care, and communicating and delivering palliative medications and interventions; 2) earlier advanced care planning; 3) increased confidence in communicating with residents’ families; 4) reducing the need for residents’ transfer to the emergency department, and 5) specialised support for the GP in delivering palliative care.
Implications for Practice
Ongoing NP involvement in the provision of specialist palliative care and education is required to sustain the benefits gained from the introduction of the Needs Rounds. Exploration of the feasibility and benefits of the Needs Rounds at other RACFs in Australia is required to better integrate palliative care services within the RACF sector.
Conclusion
The Needs Rounds were perceived to be a beneficial and successful approach to integrating specialist palliative care within RACFs, and improved the skillset of staff in identifying and managing complex palliative care needs.