There was a great article published today on the SHARE intervention (Supportive Hospice Aged Residential Exchange) which aims to promote good palliative care in Residential Care. Developed, implemented and evaluated as part of a programme of work led by Rosemary, with support from Jackie, Michal and Merryn, results of our SHARE evaluation are very positive. You can read an extract from the article below or access the full text on the Healthcentral NZ website.
Extract from article about SHARE
While there are examples of palliative care integration into residential aged care facilities from many hospices, there are few consistent models of care throughout the country, says Dr Frey, which has led to an ‘ad hoc’ approach to the integration of specialist palliative care in RAC.
The SHARE programme is a collaborative model which ensures continuity of service by placing hospice nurses alongside residential aged care staff to better understand the challenge in providing palliative care for residents.
“While there is no magic solution to enhance care delivery in residential aged care, this research is evidence of a first step in that direction.”
The new model includes focused palliative care needs assessment, clinical coaching and role modelling to help RAC and hospice staff put new learning into practice.
“The goal of SHARE is to help clinical staff improve palliative care within residential aged care facilities and to improve specialist palliative care nurses’ knowledge and skill to care for frail older people,” explains Dr Frey.
“It’s a hands-on collaborative approach that builds staff capability through reciprocal partnership and understanding. Even though RAC staff may leave, the hospice nurse is always around for new staff, either by being onsite or at the other end of the phone.”
Dr Frey says that education initiatives developed to date have focused on short training programs concentrating on the traditional “chalk and talk” format. However, there is minimal evidence that nurse and support staff knowledge gained from this format is sustained in the long term. “Adults learn best from direct experience.”
SHARE also helps improve staff confidence in palliative care delivery, including the challenging task of having difficult conversations around end of life care with residents and family members.
“One of the key components of SHARE is that palliative care needs are identified earlier – in the last year as opposed to the last week. This means discussions can happen around what the person or their relatives would like in terms of end of life care. Having people on the same page is critical.”
And it’s not just the physical needs that are discussed; the cultural, psychosocial and spiritual needs and wishes are part of the SHARE goals of care plan, which should be reviewed at least quarterly.
In the goals of care plans observed in RAC during the SHARE study, only half had the cultural and spiritual needs section filled out.
“That aspect needs to be addressed,” says Dr Frey, who is undertaking additional research in this area, in collaboration with Dr Deborah Balmer from the School of Nursing. “It has to be a team response, with social workers, hospice and RAC staff working together.”
Funded by the School of Medicine Foundation, the Freemason’s Foundation and the Health Research Council, the three-year SHARE evaluation was undertaken in collaboration with Mercy Hospice and North Shore Hospice and 20 aged care facilities.
Dr Frey says the response from the hospices and the RAC involved in the study has been very positive.
“We have evidence that SHARE works. People in need of palliative or end of life care are being identified earlier than they would have been in the past, RAC staff have an increased level of confidence in delivering palliative care, and relatives interviewed felt they were kept ‘in the loop’ about their relative’s condition. They knew what was going on and were on the same page as staff.”
She says SHARE is very much a two-way learning process, with hospice nurses saying their knowledge and skill in caring for frail older people improved. (Dr Michal Boyd and colleagues in 2011 noted a lack of gerontology expertise for palliative care specialists from hospice who may have limited experience with the complexities of care for those with frailty and dementia).
“The hospice nurses reported a new respect and knowledge regarding the care that is undertaken in residential aged care.”
Relationships between hospice and RAC staff, and consequently facility staff and residents and their families, are the key to the success of the project, says Dr Frey. “It’s not sufficient to do a one-off education session – you need the sustained presence of a hospice nurse in a facility. Relationships are key.”
For more information about SHARE, including to read publications that are out so far, please contact Rosemary Frey: firstname.lastname@example.org