Nursing - Theses
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ItemSliding doors: how we can effectively manage the transition from palliative hospice care to residential care( 2011)The increasing survival of patients with advanced-stage cancer, coupled with the increased presence of end-stage chronic illness in an ageing population, is leading to an increase in demand for patients requiring palliative care. Due to the ongoing need for acute-pain and symptom control in hospice/palliative care units, few of these are able to offer any long-stay admission for those whose symptoms have been stabilised. Transfer from an inpatient palliative care facility may then be necessary, when a patient is considered to be no longer requiring specialist palliative care services. A core component of the role of palliative-care social workers involves working with patients and their families/carers1 when the care pathway shifts and the option of residential care (in this context, nursing homes) needs to be considered. As a social work clinician, I have observed that, when this process has been considered or contemplated, the patient and their families often display anxiety, anger and distress. This practice research study has explored several issues, including the impact of this transition on the patient and their families and on the interdisciplinary healthcare team treating the patient. This study has analysed this phenomenon in two ways. In the first part of the study, a data-mining process was utilised. A sample of 30 consecutive patients who were assessed as being eligible for high-level care (or nursing-home level care) was included. Medical files/histories were reviewed using an audit tool that was developed based on the literature review. The salient or pertinent characteristics of the population group were documented. In the second part of the study, an investigation was undertaken to identify concerns and barriers regarding the transition from hospice care to residential care and highlight the opportunities to improve clinical practice in this area. This investigation analysed the literature and clinical practice, and interviewed the key stakeholders involved in this process. A tripartite approach was adopted by conducting face-to-face interviews with patients, their carers and members of the interdisciplinary healthcare team. As social work clinicians have a substantive role in this area of transition, telephone interviews were also conducted with 10 social workers working in similar inpatient palliative-care facilities in the area of Victoria to gauge their experiences. A thematic analysis discerned a number of common themes highlighting the impact and difficulties of this transition on the key stakeholders. The results suggested recommendations to improve or best manage this process and service delivery. The research study has highlighted the difficulties that patients/families encounter in the transition from palliative care in a hospice to nursing home care and emphasises the importance of protecting the integrity of the patient and family by holding open and continuous dialogue, particularly through family meetings, and working in collaboration with the patient, the family and the team. Understanding the experience of this transition is crucial to the knowledge required to provide psychosocial care to this population. This practice-based research study incorporates the ‘voices’ of terminally ill patients, families and members of the healthcare team on matters directly affecting them. Their views and recommendations for best managing the transition from a hospice/inpatient palliative-care facility to a residential-care facility has been documented with the hope of enabling their input to have some real impetus on clinical practice and service delivery. The importance of this work is that it highlights issues that can arise in the terminal phase of illness and illustrates the benefits of practice based, qualitative research.