These comprehensive workbooks guides nurses new and transitioning to general practice or aged care through key components of these areas of nursing, and will ensure a thorough understanding of the many facets of these primary health care settings.
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Primary health care is any medical service that is provided outside the four walls of a hospital, including aged care, community health, general practice, custodial, schools and many other primary health care settings. Australia's 98,000+ primary health care nurses play a critical role in disease prevention and control to keep people healthy. They provide proactive care and health promotion to keep Australians well.
Jane Stephens, Clinical Nurse Consultant, caring@home
Natalie Blauensteiner, Communications Manager, caring@home
Can primary health care nurses successfully support home-based patients at the end of their lives? The answer is, yes, they can. Practical and evidence-based resources from caring@home can help.
Many Australians express a preference to die at home, but only a small percentage achieve this goal. Primary health care nurses can support patients who are approaching the end of their lives, and who would like to be cared for and, in some cases, to die at home.
Funded by the Australian Government, caring@home is a National Palliative Care project. We have developed a suite of free, practical and evidence-based resources that are designed to support primary health care nurses to plan for and provide quality end-of-life care for patients and their carers and families. The following three resources are part of this suite.
The Prompts for End-of-Life Planning (PELP) Framework guides proactive, quality end-of-life care across all care settings. If a death is predicted, it can be planned for.
The PELP Framework starts with the identification of patients who would benefit from a palliative approach. This can be as simple as asking the surprisingly accurate ‘surprise question’: ‘Would you be surprised if the person died in the next twelve months?’
Identification of a patient at risk of deteriorating and dying prompts meaningful conversations about their care goals and preferences.
These ongoing discussions help create person-centred management plans that reflect the person's wishes and reduce the need for difficult decision-making during emotional times.
The PELP Framework identifies four clinical end-of-life processes:
Advance care planning and person-centred care based on need (at risk of dying)
Transition focus of care needs from restorative to palliative (likely to die soon)
Terminal care needs (dying)
After-death care (bereavement).
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The ‘Terminal care planning checklist for nurses in the community’ identifies the actions required in planning for the person who wishes to die at home, including practical, spiritual, emotional and cultural considerations.
This document is a comprehensive, practical checklist to assist primary health care nurses with providing care to a person at home in their final hours, days, or week.
Jane Stephens is the clinical nurse consultant for caring@home. Jane says that for nurses unfamiliar with the nuances of planning for a person to die at home, the checklist is a great place to start.
‘The checklist helps to guide a nurse or care team on all the things they need to think about to support the care of a dying person in their home,’ says Jane.
‘It’s all about planning in advance and being prepared. Using this checklist as a guide ensures that the necessary interventions are actioned by the care team and family. These actions can prevent unnecessary admissions to acute care settings for people at end-of-life, which may not be in line with their wishes.’
The Community Palliative Care Resources Box is a free package that supports quality and timely palliative care for home-based patients.
Primary health care nurses can use the resources and help inform families and carers about managing physical symptoms, recognising dying, understanding infusion devices, providing practical care and helping to manage symptoms with subcutaneous medicines for a person at home.
‘The Community Palliative Care Resources Box can be ordered by clinical services who are providing palliative care,’ says Jane. ‘The nurse can choose the relevant resources from the box and use these to educate family or carers helping to look after a dying person.’
‘We’ve had an excellent response to these resources, which are visually appealing and have easy readability. We also have culturally appropriate resources developed with and for First Nations families and translated resources in nine commonly spoken languages.’
Primary health care nurses can successfully help to support palliative care patients who would like to be cared for and die at home by using the caring@home resources. For access to these and other resources, visit www.caringathomeproject.com.au.
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Fictional case study: Supporting a patient who wants to die at home Picture this: You work as a primary health care nurse at a general practice on the outskirts of a large regional town. Sue is a long-term patient of the practice. She recently celebrated her 84th birthday. Sue has become noticeably frailer over the past few months. Recent blood tests show deteriorating renal function, and she’s had several admissions to hospital due to exacerbations of her chronic obstructive pulmonary disease. You would not be surprised if one of these exacerbations resulted in Sue’s death. Sue’s symptoms include dyspnoea, fatigue and anxiety. She tells you that she has had enough of hospitals and would like to try to manage at home from now on. Sue’s daughter Emily would like to try to support her mother at home but is unsure what this involves. As a nurse, you want to support Sue in her wish to remain at home, but you’re not sure where to start… caring@home has developed a whole suite of resources that will help you to provide quality care for Sue and Emily. Visit www.caringathomeproject.com.au to get started. |
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