Readiness for providing primary palliative care in regional Aged Residential Care: Partnering with SEQUAL specialist palliative care nurses

Abstract
Increasing numbers of older New Zealanders are spending their last days of life in Aged Residential Care (ARC), traditionally rehabilitative-focused. Current trends suggest realignment towards a palliative approach to care is needed. While the New Zealand government has committed to providing quality palliative care, available to all irrespective of where they live, the need for a supportive partnership between regional ARC and specialist palliative care services has not been established. A pilot study was conducted by a specialist Supportive Education and Quality palliative care (SEQUAL) team in five ARC facilities within regional New Zealand. A clinical staff survey (n = 84) and facility desktop document review were undertaken to determine readiness, need for and level of support required to enhance primary palliative care for residents. Each of the five facilities was found to document few indicators for a palliative care approach in care philosophy or delivery plans. While the majority of clinical staff (Registered Nurses /Health Care Assistants), reported spending more than 50% of their time with residents in their final year of life, not all felt confident to do so. No palliative care education had been received by 42% (n=36) of respondents. Implementing a specialist palliative care partnership to support facility re-alignment of care philosophy, policies and procedural guidelines, with additional clinical staff palliative care education would provide a platform to implement a palliative care approach in regional ARC settings. This would signal the intent of the organisations to provide an individualised quality palliative care experience for residents.

Ngā ariā matua
Kei te piki haere te tokomaha o ngā tāngata o Aotearoa ka noho i ō rātou tau whakamutunga i tēnei ao i ngā Whare Tiaki Kaumātua (ARC), ā, ko tōna aronga nui i ngā tau ki muri he whakapakari anō i te tangata i roto i ngā māuiui. Ki ngā whakaaaro mātanga o ēnei rā, me whakahāngai kē ēnei mahi ki ngā tikanga whakamāmā i te mate taumaha o te tangata. Ahakoa e ū ana te kāwanatanga o Aotearoa (NZ) ki ngā mahi whakamāmā i te mate taumaha kounga tiketike mō te katoa, ahakoa kei whea rātou e noho ana, kāore anō kia whakatūria he mahi kōtui tautoko i waenga i ngā ARC ā-rohe, me ngā ratonga whakamāmā i te mate taumaha. I kawea tētahi rangahau whakamātautau e tētahi rōpū Akoranga Tautoko, Mahi Tiaki Whakamāmā i te Mate Taumaha Kounga Tiketike (SEQUAL) i ētahi pūtahi ARC e rima i ngā rohe o Aotearoa. I whakahaeretia he uiuinga kaimahi tiaki tūroro (n=84) me tētahi arotakenga pukapuka papamahi ā-whakahaere hei tiro i te takatū, i te nui o te hiahia, me ngā taumata tautoko e tika ana hei whakapiki i te tiaki mō ngā mate taumaha o te hunga noho i roto. I kitea i ngā whakahaere e rima, kāore i nui ngā tohu mō te whai i te huarahi tiaki whakamāmā i te mate taumaha i ngā ariā tiaki, i ngā mahere tiaki tūroro rānei. Ahakoa i puta te kōrero a te nuinga o ngā kaimahi tiaki tūroro (Tapuhi Rēhita/Kaiāwhina Tiaki Tūroro), ka pau i a rātou neke atu i te 50% o tō rātou wā i te mahi i te taha o ngā kaumātua kua tae ki te tau whakamutunga mō rātou i tēnei ao, kāore te katoa i māia kia pērā. Kāore kau he akoranga whakamāmā i ngā mate taumaha o te 42% (n=36) o te hunga i whakautu. Mā te whakatinana i tētahi mahi kōtui mō te whakamāmā i te mate taumaha hei tautoko i te whakahāngaitanga kētanga o ngā ariā tiaki, o ngā kaupapa here me ngā aratohu tikanga mahi, me te whakapiki i te akoranga whakamāmā mate taumaha o ngā kaimahi tiaki tūroro i te taha, e hora ai he pūhara pai hei whakatinana kaupapa whakamāmā mate taumaha i ngā horopaki ARC ā-rohe. Mā tēnei anō hoki e waitohu te whāinga o ngā whakahaere kia horawheako whakamāmā i te mate taumaha e hāngai ana ki te tūroro takitahi.

Keywords / Ngā kupu matua
Primary palliative care/ Te tiaki whakamāmā i te mate taumaha matua; Aged Residential Care/ Te Tiaki Kaumātua i ngā Whare Kaumātua; regional/ ā-rohe; confidence/ māia; education/akoranga