A recent study, Good end-of-life care in nursing home according to the family carers’ perspective: A systematic review of qualitative findings, which was released in Palliative Medicine last month looked into perceptions of good end-of-life according to family carers.

The research was done by searching five electronic databases between April and May 2018 of studies conducted in the United States, Europe, Canada and New Zealand.

It concluded that family carers desired “a care aimed at early identification and treatment of physical, psychological and spiritual problems”.

“According to our model, the adoption of a palliative approach starts from recognising physical or social triggers, and it is sustained by an environment characterised by adequate staffing, staff trained in palliative care, supportive physical environment and local policies directed at promoting patient-focused and family-centred care.”

University of Auckland School of Nursing associate professor and nurse practitioner, Dr Michal Boyd, said the quality of death in residential aged care facilities in New Zealand is one of the best in the world but agreed proper training is needed to provide good care.

“Education of support staff is very important, it all starts from the leadership and management. You’ve got to make sure the managers of facilities are really good at what they’re doing as it sets the tone,” she said.

“I think there needs to be more education for caregivers, education that really makes a difference…it needs to be practical, education on the floor, not just lectures.

“We need onsite education and critical coaching.”

Boyd, who specialises in the care of older adults in residential aged care facilities, also said an improvement in staffing levels would help in providing quality end-of-life care.

“The whole industry is stressed, we’re being asked to care for more and more critically ill people.”

There are programmes which are working well in New Zealand already, such as The Supportive Hospice and Aged Residential Exchange (SHARE) programme that integrates palliative care specialists into care homes to support staff with end-of-life care, she said.

“The staff actually showed less burn-out and depression with this support.”

Communication between staff and family, including advance care planning discussions, were also another key component of good care, according to the research.

“Recognition of resident deterioration and whether it is reversible or not is key good care overall, and this requires highly trained caregivers and staff,” Boyd said.

The research identified four elements that influenced end-of-life care environments including staffing levels, staff characteristics in terms of knowledge and training, a comfortable physical environment and institutional policies.

“When there is a patient-centred environment, the provision of good end-of-life care is more likely,” the report said.

“This suggests the need of improving education regarding palliative care.”

The report said that family carers described good end-of-life care as providing resident basic care and spiritual support; recognising and treating symptoms; assuring continuity in care; respecting resident’s end-of-life wishes; offering environmental, emotional and psychosocial support; keeping family informed; promoting family understanding; and establishing a partnership with family carers by involving and guiding them in a shared decision-making.

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