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"Behind the blue door" : developing the practices of aged care staff around a palliative approach in a dementia special care unit

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Andrews-Hall, S (2010) "Behind the blue door" : developing the practices of aged care staff around a palliative approach in a dementia special care unit. PhD thesis, University of Tasmania.

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Abstract

The adoption of a palliative approach to the care within Australian Residential Aged
Care Facilities (RACFs) has been supported by a range of policy and best-practice
initiatives. There is a considerable body of evidence demonstrating that most people
who live in RACFs are highly dependent, are likely to have dementia and will die in
these locations. Dementia is recognised to be a terminal condition, further
underscoring the need for appropriate and timely care. However, issues of equity and
quality of palliative care for people with dementia have raised concerns about the
capacity of RACFs to deliver a palliative approach to care. Therefore, this research
located within a RACF in Tasmania, Australia, sought to address the question: what
are the possibilities for aged care staff to develop their practices around a palliative
approach to care for people with dementia and their family caregivers?
The study employed a critical action research method wherein, nursing and care staff
members (n=5) from a dementia special care unit (SCU) formed an action research
group (ARG). With a desire to explore and improve their palliative care practices, the
ARG members engaged in a critical change agenda over an 18 month period. In
Stage One of the study, a preliminary investigation collected baseline from ARG
meetings (n=11), staff questionnaires (n=37), interviews with family caregivers of
residents from the SCU (n=10), stakeholders dialogues (n=6); and an audit of
resident files (n=21). Through their critical reflection on the baseline findings, the
ARG members identified three areas of practice in need of improvement these being,
i) staff knowledge of a palliative approach, (ii) family caregivers’ access to
information and, (iii) evidence-based strategies for pain management and palliative
care planning. During Stage Two, the ARG members continued to meet (n=7) as co-researchers
and developed four action plans to address these concerns. During this
process they shared an emerging sense of empowerment as they imagined
possibilities for change. In Stage Three, the group members implemented their action
plans through five successive action cycles and met (n=9) to critically reflect on the
outcomes. This study illustrates that a complexity of competing economic, sociopolitical
and cultural interests shape the possibilities for aged care staff to
reconfigure their practices to support a palliative approach to care. It is imperative to
provide opportunities for staff to engage in critical, collaborative dialogue as a means
to exposing the taken-for-granted understandings that constrain innovation.

Item Type: Thesis (PhD)
Keywords: Palliative approach, dementia, aged care, action research
Copyright Information:

Copyright 2010 the author

Date Deposited: 06 Aug 2015 02:26
Last Modified: 19 Jul 2016 23:22
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