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Townsville
PALLIATIVECAREQLD.ORG.AU/CELCThis project is administered by Palliative Care Queensland and
supported by funding from the Australian Government through the PHN Program.
The CELC North Queensland projects are administered by Palliative Care Queensland and supported by funding from the North Queensland PHN
through the Australian Government’s PHN program
Mackay
PALLIATIVECAREQLD.ORG.AU/CELCThis project is administered by Palliative Care Queensland and
supported by funding from the Australian Government through the PHN Program.
The CELC North Queensland projects are administered by Palliative Care Queensland and supported by funding from the North Queensland PHN
through the Australian Government’s PHN program
The CELC North Queensland projects are administered by Palliative Care Queensland and supported by funding from North Queensland PHN through the Australian Government’s PHN program
PROJECT REPORT 2017 - 2019
CONNECTING END OF LIFE CARE IN
TOWNSVILLE
CLEC_T_V1
TABLECONTENTS
OF
Acknowledgements .......................................................................................................................................................... 3
Executive Summary .......................................................................................................................................................... 4
Background.......................................................................................................................................................................... 8
Connecting Systems .......................................................................................................................................................12
Connecting Systems | Activity 1: Training Needs Analysis ................................................................................14
Connecting Systems | Activity 2: Community Survey .........................................................................................31
Connecting Systems | Activity 3: Townsville Palliative Care services and supports mapping and
directory .............................................................................................................................................................................34
Connecting Systems | Activity 4: Palliative Care in Aged Care Round Table ...............................................36
Connecting Practice .......................................................................................................................................................39
Connecting Practice | Activity 5: Practice Development Program .................................................................41
Connecting Practice | Activity 6: I CARE for my resident with palliative needs resource kit ................46
Connecting Practice | Activity 7: CELC-NQ Special Interest Group ...............................................................50
Connecting community .................................................................................................................................................52
Connecting Community | Activity 8: Community Engagement Activities ...................................................54
Connecting Community | Activity 9: Good Life Good Death expo ..................................................................57
Project recommendations for Townsville ...............................................................................................................60
Definition and Abbreviations ......................................................................................................................................62
Page: 3 of 65CONNECTING END OF LIFE CARE IN TOWNSVILLE PROJECT REPORT | 2017 - 2019
Acknowledgements
Palliative Care Queensland acknowledges the Traditional Custodians of the lands and seas on which we live
and work, and pay our respects to Elders past, present and emerging.
Palliative Care Queensland would like to acknowledge all the project participants, residential aged care staff,
all the residents with palliative needs and the Steering Committee members involved for their support and
time in participating in the Connecting End of Life Care – Townsville [CELC-T] project.
This report has been written by PCQ CEO Shyla Mills, CELC Program Manager Marg Adams, Project Officers
Sharon Ho and Smita Gupta.
We understand that time is precious, and life is busy, and we appreciate everyone who has contributed in
sharing, experience, knowledge and time with us.
Page: 4 of 65 CONNECTING END OF LIFE CARE IN TOWNSVILLE PROJECT REPORT | 2017 - 2019
1 Source from https://itt.abs.gov.au/itt/r.jsp?RegionSummary®ion=318&dataset=ABS_REGIONAL_ASGS&geoconcept=REGION&measure=MEASURE&datasetASGS=ABS_
REGIONAL_ASGS&datasetLGA=ABS_REGIONAL_LGA®ionLGA=REGION®ionASGS=REGION
2 Sourced from https://www.agedcare101.com.au/aged-care/qld/townsville/region
Executive Summary
This report presents the findings of the Connecting End-of-Life Care in Townsville [CELC-T] project
conducted from 2017 to 2019. This report was conducted over a 24-month period in two stages. The initial
stage included a focus only on the greater Townsville region, this was then expanded to include the whole
Townsville Hospital and Health service region. The CELC-T project has been administered by Palliative Care
Queensland [PCQ] and funded by the Australian Government through the Northern Queensland Primary
Health Network [NQ PHN].
The purpose of the CELC-T was to improve knowledge and confidence in relation to end-of-life-care [EOLC]
planning hereby assisting in the management of after-hours service need.
The area of land of the Townsville region is 8,001,625.8 ha1. There is a population of 238,233 people in
Townsville with 66.9% of the population at working age1. 12.5% of the population in Townsville is 65 years or
older1. According to a desktop search of residential aged care [RAC] services in Townsville, there is a total of
19 RAC services identified in Townsville2.
The CELC-T project target audience was all residential aged care [RAC] staff, general practice staff, Aboriginal
Medical Services, Hospital and Health Services and community-based palliative care services, community
groups and community members within the NQPHN region.
CELC-T Project Aims and Activities:
The CELC-T project recognised that to make improvements in palliative care three area needed to be targeted
– systems, practice (ie interdisciplinary practice) and community (ie. Culture). Therefore, the project had
three main aims and included nine key activities:
1. Aim 1: Connecting Systems
Understanding current systems, understanding key issues and opportunities and connecting
relevant systems
- Activity 1: RAC Training Needs Analysis
- Activity 2: Community Survey
- Activity 3: Townsville Palliative Care Services and Supports Mapping and Directory
- Activity 4: Palliative Care in Aged Care Round Table
2. Aim 2: Connecting Practice
Improving the knowledge and confidence of the interdisciplinary teams providing holistic care and
connecting teams and roles
- Activity 5: Practice Development Program
- Activity 6: I CARE for my residents with palliative needs resource kit
- Activity 7: CELC-NQ Special Interest Group
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1 Source from https://itt.abs.gov.au/itt/r.jsp?RegionSummary®ion=318&dataset=ABS_REGIONAL_ASGS&geoconcept=REGION&measure=MEASURE&datasetASGS=ABS_
REGIONAL_ASGS&datasetLGA=ABS_REGIONAL_LGA®ionLGA=REGION®ionASGS=REGION
2 Sourced from https://www.agedcare101.com.au/aged-care/qld/townsville/region
3. Aim 3: Connecting Community
Creating community awareness and understanding about palliative care, services and supports and
connecting community groups and members with an interest in palliative care
- Activity 8: Community Engagement Activities
- Activity 9: Good Life Good Death expo
CELC-T Project Participation:
• Over 1,200 people directly participated in the CELC-T project activities
o Including 395 in the RAC Training Needs Analysis, 337 in the Townsville Community Survey, 21
in the Palliative Care in Aged Care Round Table, 58 in the Practice Development Program
workshops and 400 in the Townsville Good Life Good Death expo.
• The program was featured in the local media 3 times
o Including ABC North Queensland radio, Channel 7 news and in the Townsville Bulletin.
• 45 Palliative Care Services and Supports were mapped
• Countless community and health professional conversations about loss, ageing, dying and grief occurred
CELC-T Project Outcomes:
Key Learnings from our Connecting Systems Activities:
Top five challenges to providing palliative care in RAC service Townsville
• Lack of staff/staffing
• Lack of access to resources – medical help/GP/after-hours
• Family request to do something different to the ACP
• Communication – family not wanting to be notified when resident dies
• Poor symptom control
Four key reasons for hospital transfer from RAC services for residents with palliative care needs in
Townsville
• Lack of knowledge
• Family request
• Lack of access to resources – medications after-hours
• Hospital is better suited to care for palliative/end-of-life-care residents
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Four key recommendations were identified as part of the Townsville Community Survey
• Increase community confidence to source quality palliative care information
• Increase community confidence in facilitating conversations about end of life
• Improve health professional’s ability to explain the process of end of life care
• Share patient experiences and stories about end of life
Ten opportunities identified from the Townsville Palliative Care in Aged Care Round Table
• Develop local strategy network to ensure sustain conversations and facilitate change
• Facilitate Consumer engagement – Consumer Round table with all RACFs inviting residents
and families
• Goals of Care | Advanced Care Planning – discussions with RACF public and RACF private to
have consistent documentation – work with QAS to identify issues
• Training focus in communication and compassion – embed training needs orientation and
appraisal systems.
• Ensure General Palliative Care is on the agenda at every DON/F< RACF Townsville Meeting
• Paramedics and QAS – Opportunity for linkages/pathways between LARU, Specialist Palliative
Care services and RACF
• Understanding dying pathways – strengths & room for improvements: recognized with case
reviews/death audits attended by Acute/Specialist/RACF staff
• Mapping of GP services & Pharmacy services to RACF – particularly in afterhours
• Recognising dying – clinical and consumer awareness of how to recognise and communicate
dying needs using appropriate common language
• Investigate Nurse Practitioner led Model – case management/case conferencing, linkage
between RACF & Hospital, mentorship and trainings
Key Learnings from our Connecting Practice Activities:
Practice development programs participants take home messages:
• There are resources available [for palliative care]
• Communication with everyone involved is important – including family
• Early planning of end-of-life care is needed
• Everyone has role in end-of-life-care
• Palliative care is not giving up
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Key Learnings from our Connecting Community Activities:
• Attendees would like to know more about Palliative Care and upcoming relative activities
• Statement of choice, and the PCA discussion starters were popular resources
• Free Henna tattoo provide an incentive to attracting people of all ages and inviting them to join our
conversation on palliative care and what matters most. While having henna, it provided an
opportunity to chat with the attendees and know about their perspective on palliative care
• The Before I Die banner is easy for people to engage with and prompts conversation starters
• Positive feedback from 1 GP, who could not gain permission to display the banner in their waiting
room, therefore displayed it in his consult room – he noted that this helped start conversations
about palliative care with his patients.
• School art competitions are an effective method to engage schools in conversations about caring
and loss
• Local Councils are very supportive of community initiatives and compassionate communities
CELC-T Project Recommendations
• Consider extending the TNA and PDP into acute and community settings to improve understanding
and connections between and across sectors
• Evaluation of Special Interest Group impact on improving connections and conversations between
sectors to demystify service context and establish collegial respect for challenges and opportunities
to improve good day time planning for people with palliative care needs
• Continue the implementation of the ICARE for my resident resource kit and follow up on integration
• Continue to facilitate discussions between national projects to avoid duplication of activity and
increase awareness of sector need
• Provide regular/accessible education/information on general palliative care to ‘refresh’ on
knowledge and specific medication and alternative pain management strategies
• Encourage RAC services to provide training and support to staff regarding dealing with increased
pressure from families
• Encourage RAC services linking with innovative models of service to support clinical decision making
and mentorship
• Consider technology to support engagement with clinical support afterhours such as telehealth –
models that need further exploration and can demonstrate impact on outcomes for hospital avoidance
• Add community engagement into future palliative care projects within the region, to extend to
impact of the project and support for service providers and consumers
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BACKGROUND
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About the project
The Palliative Care Queensland (PCQ) Connecting End of Life Care (CELC) program adapts to local needs.
PCQ developed the first CELC program in 2017 with Northern Queensland Primary Health Network
(NQPHN), following this we have rolled out activities in Mackay, Cairns, Gold Coast, Darling Downs and West
Moreton. Current active CELC projects are underway in Townsville, Cape York and Brisbane North.
The aim of the Connecting End of Life Care in Townsville (CELC-T) project was to improve the capacity
and capability of residential aged care (RAC) staff and General Practice (GP) service providers within the
Townsville Hospital and Health Services (HHS) region. CELC-T aimed to provide quality palliative care and
end-of-life planning thereby assisting in the management of after-hours service need.
This report summarises the first two stages of the CELC-T project, which was conducted over a 2-year period
between April 2017 and June 2019. The initial stage included a focus only on the greater Townsville region,
this was then expanded to include the whole Townsville Hospital and Health service region in stage two.
Stage 1 and 2 have had a specific focused on the RAC setting. The CELC-T project is continuing in 2019-2020,
this will continue to focus on the whole Townsville HHS region and will expand beyond RAC to all primary
palliative care providers within the region.
In parallel to the CELC-T stage two project, PCQ administrated two other CELC projects in Mackay (CELC-M)
and Cairns (CELC-C) which were funding by NQPHN Due to the similar nature of the three projects, often
these three projects were referred to as CELC North Queensland (CELC-NQ).
Page: 10 of 65 CONNECTING END OF LIFE CARE IN TOWNSVILLE PROJECT REPORT | 2017 - 2019
Key aspects of the CELC-T project included:
• Build relationships, partnerships and linkages with key stakeholders, local, national and federal
projects and relevant peak-bodies
• Collaborate with the primary palliative care workforce to identify gaps and challenges in their
training and leadership needs, and to create a network of support linking them to relevant evidence-
based resources and experts
• Deliver an education program that creates a baseline of knowledge and understanding about caring
for older people in their end phase of life.
The CELC-T project recognised that to make improvements in palliative care three area needed to be targeted
– systems, practice (ie interdisciplinary practice) and community (ie. Culture). Therefore, the project had three
main aims and included nine key activities:
1. Aim 1: Connecting Systems
Understanding current systems, understanding key issues and opportunities and connecting
relevant systems
- Activity 1: RAC Training Needs Analysis
- Activity 2: Community Survey
- Activity 3: Townsville Palliative Care Services and Supports Mapping and Directory
- Activity 4: Palliative Care in Aged Care Round Table
2. Aim 2: Connecting Practice
Improving the knowledge and confidence of the interdisciplinary teams providing holistic care and
connecting teams and roles
- Activity 5: Practice Development Program
- Activity 6: I CARE for my residents with palliative needs resource kit
- Activity 7: CELC-NQ Special Interest Group
3. Aim 3: Connecting Community
Creating community awareness and understanding about palliative care, services and supports and
connecting community groups and members with an interest in palliative care
- Activity 8: Community Engagement Activities
- Activity 9: Good Life Good Death expo
Project Governance
The CELC-T Project Steering Committee (The Committee) provides oversight of the project. The Committee
is responsible for establishing project direction, setting program deliverables and providing leadership in
the development, introduction and implementation of the CELC-T Project. The Committee is comprised of
key stakeholders internal and external to the palliative and aged care sectors and is accountable to the PCQ
State Council.
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About Palliative Care Queensland (PCQ)
Palliative Care Queensland (PCQ) is an independent not-for-profit peak body with charitable status
representing the people who care for Queenslanders living with life limiting conditions. Queensland
Compassionate Communities (QCC) is the community arm of Palliative Care.
Our belief: The way we care for our dying is a significant indicator of our society’s values
Our mission: Quality care at the end of life for all
Our vision: To hear Queensland community members say:
“I live in a community where everybody recognises that we all have a role to play in supporting each other
in times of loss, ageing, dying and grief. We are ready, willing and confident to have conversations about
living, ageing, dying and grieving well, and to support each other in emotional and practical ways”.
PCQ has been operating for over 30 years, has over 400 members and is a founding member of Palliative Care
Australia. PCQ members include health professionals across all sectors of health, specialist and generalist
palliative care services, aged care, disability care, peak bodies, as well as consumers and interested members
of the Queensland community. Collectively, the PCQ membership body holds tremendous knowledge and
wisdom about the challenges the sector faces and the opportunities those challenges can bring.
About Northern Queensland Primary Health Network
Northern Queensland Primary Health Network (NQPHN) is an independent, not-for-profit organisation funded
by the Australian Government to commission services to meet the health needs and priorities of our region.
Their purpose is to ensure access to primary health care services respond to the individual and community
needs that are relevant to their culture and delivered by an appropriately skilled workforce.
The NQPHN region covers four HHS of Cape and Torres, Cairns and Hinterland, Townsville and Mackay.
Map from https://www.health.qld.gov.au/maps/mapto/townsville
Page: 12 of 65 CONNECTING END OF LIFE CARE IN TOWNSVILLE PROJECT REPORT | 2017 - 2019
CONNECTING SYSTEMS
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Page: 14 of 65 CONNECTING END OF LIFE CARE IN TOWNSVILLE PROJECT REPORT | 2017 - 2019
TRAINING NEEDS ANALYSIS
Connecting Systems | Activity 1:
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Purpose of the Training Needs Analysis
The purpose of the Residential Aged Care (RAC) training needs analysis (TNA) was to identify the specific
clinical and related skills required by RAC staff in the delivery of palliative care for residents and to determine
appropriate methods for developing these skills in the Townsville HHS region.
The primary objective of the TNA was to identify needs related to training in the following five areas:
1. Training Needs Area 1: Knowledge needs
3. Training Needs Area 3: Resource awareness
2. Training Needs Area 2: Confidence needs
4. Training Needs Area 4: Challenges and barriers
5. Training Needs Area 5: Training interest and modality
Identifying their current self-assed knowledge about palliative and end-of-life care
Awareness of state-wide and national palliative care project resources
Identify their current self-assessed confidence in supporting and caring of palliative or end-of-life care resident
Identification of challenges and barriers in providing excellent palliative care in aged care during after-hours
Training interest and modality preference
TNA methodology
Palliative Care Queensland conducted the TNA in the CELC-T project in two stages
• The CELC-T1 (Greater Townsville region) TNA was conducted in March 2018.
10 RACs were eligible to participate
• The CELC-T2 (Townsville HHS, excluding the Greater Townsville region) TNA was conducted in
September/October 2018.
9 RACs were eligible to participate
The TNA methodology aimed to maximise engagement of aged care staff recognising the challenges with
variety of shift times and general capacity. Therefore, the CELC TNA includes two parts:
1. All RAC staff training needs survey (The All Staff Survey)
o Staff were divided into three categories, recognizing scope and role differences. The All Staff
Survey was used to analyse all five training needs areas.
Page: 16 of 65 CONNECTING END OF LIFE CARE IN TOWNSVILLE PROJECT REPORT | 2017 - 2019
2. Facility manager training needs analysis focus group questions (The FM Questionnaire)
o A structured interview questionnaire developed to guide the CELC-T Project Officer to ask a
series of questions to all identified levels and roles of RAC staff and Facility managers. The FM
Questionnaire was used to analyse training needs area 4 and 5 only.
TNA tool development
The All staff survey tool and the FM Questionnaire tool were developed based on recommendations from the
Palliative Approach Toolkit and discussions with The Committee members [CELC-T1 and CELC-T2]. The tools
were adapted slightly between CELC-T1 implementation and CELC-T2 implementation, based on feedback
from CELC-T1 participants and the experience of the project team.
TNA data collection methodologyParticipation eligibility
A total of 19 RAC services were identified as eligible to participate in the CELC-T TNA. These RAC services
were identified with NQPHN team.
10 identified during CELC-T1 and 9 identified in CELC-T2.
These RAC services are listed below.
CELC-T1 CELC-T2
Arcare North Shore Blue Care Bluehaven Aged Care Facility
Blue Care Shalom Elders Village Sandy Boyd Aged Care Hostel Palm Island
Blue Care Townsville Mt Louisa Aged Care Facilty Canossa Residential Services Trebonne
Bolton Clarke, Rowes Bay Churches of Christ Care Palms Aged Care
Carinity Fairfield Churches of Christ Care Rockingham Aged Care
Good Shepherd Nursing Home Dalrymple Villa - low care assisted living
Loreto Home for Aged Care Eventide Aged Care Facility
OzCare Villa Vincents Lower Burdekin Home for the Aged (Ayr)
Parkland Kirwan Lower Burdekin Home for the Aged (Homefield)
Regis Kirwan
Data received
- 79% of the eligible services participated in CELC-T TNA
o CELC-T1 TNA: 100% of the eligible services participated
• All Staff Survey: 80% of eligible services participated
• Facility Manager Questionnaire: 90% of eligible services participated
• Note: the 1 service that did not participate in the FM Questionnaire did participate in the All Staff Survey.
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o CELC-T2 TNA: 56% of the eligible services participated
• All Staff Survey: 56% (5/9) of eligible services participated
• Facility Manager Questionnaire: 56% of eligible services participated
• Note: the 4 services that did not participate in either the all staff survey or the FM questionnaires. The key reason for declining to participate in the TNA was capacity of the RAC.
Data collection: The All staff survey
The All Staff Survey was collected through paper based and online survey tools.
A total of 381 All Staff Survey responses were collected from 14 RAC services from CELC-T Project
A total of 200 responses were collected from 8 RAC services from CELC-T1.
A total of 181 responses were collected from 5 RAC services from CELC-T2.
The All staff survey were divided into three categories, recognizing scope and role differences. Participation
per category for CELC-T TNA was as follows:
• Category 1: RNs, ENs, Managers, Quality staff and Education staff
o 83 Category 1 staff participated in CELC-T TNA All Staff Surveys
• Representing 22% of the TNA all participation
• Category 2: Allied Health, Carer/Assistant in Nursing [AINs]/Personal care workers [PCW], Team
Leaders, Activities Coordinators/Officers and Pastoral/Spiritual carers
o 177 Category 2 staff participated in CELC-T TNA All Staff Surveys
• Representing 46% of the TNA All Staff Survey participation
• Category 3: Reception staff, cleaners and domestic staff, laundry staff and volunteers
o 121 Category 3 staff participated in CELC-T TNA All Staff Surveys
• Representing 32% of the TNA All Staff Survey participation
The majority of participants were from Category 2 (46%), which is reflective of the bulk of the RAC workforce.
Data collection: FM Questionnaire
The FM interviews data was collected through face-to-face interviews for CELC-T1. Due to the short turn
around to conduct The All staff survey, a revised methodology was undertaken to capture the feedback of
RAC Facility Managers located in the Townsville HHS. Methods included telephone interviews or an email
with a PDF version of the manager survey.
All Facility Managers had an opportunity to contribute their feedback to the TNA arm of the project.
Facility Managers unable to participate in the TNA survey were provided with an opportunity to discuss
perceived challenges and opportunities in providing care to their residents with palliative needs, particularly
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after-hours. Contact with Facility Managers was ongoing, enabling Facility Managers to provide formal and
informal feedback about the needs of their staff.
A total of 14 FM Questionnaire responses were collected from 14 RAC services from CELC-T Project
A total of 9 responses were collected from 9 RAC services from CELC-T1. A total of 5 responses were collected from 5 RAC services from CELC-T2 1 FM covered two RAC
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RAC Training Needs Analysis implementation process
Introductory email to RAC Facility Managers
Telephone and or email follow up to all RAC to confirm postal address
Information packages circulated
FM Questionnaire and The All staff survey completed
Returned to PCQ and manually entered into survey monkey
• Introductory email circulated to all RAC Facility Managers in the Townsville HHS region – 20 RAC
Facility Managers (note 1 FM covered two RAC services).
• Facility Managers provided with an information package containing details on CELC-T ‘About the CELC-T
project flyer’ and copies of the finalised CELC-T surveys. Category 1,2,3; proposed distribution process for
The All staff survey; in RAC services discussed and key contact identified.
• The All Staff Survey packs were circluated
• The FM Questionnaire was circulated – managers
were invited to complete during the meeting or
return to Project Officer at a time convenient.
• Hand delivered
• Expressed post
• Printed by Facility Manager
• The All staff survey distribution plan – feedback was sought from the group regarding the draft survey
distribution plan. The suggestion of conducting ‘survey week/s’ at the facility and/or identifying key
contact at each site to assist with circulation/collection of survey was considered by the Facility Manager
as the most appropriate way to proceed with data collection.
• Phone or email contact was encouraged to answer questions
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TNA Promotion
Several strategies were undertaken to assist with the promotion and participation of staff in the CELC-T
TNA, including:
• Promotional flyers and posters
• Updates on social media platforms including Facebook, Twitter, Linked In, PCQ eNews, NQPHN
Communications platforms
• Local Steering Committee and associated networks
• Local conference and workshops hosted in the Townsville HHS region
TNA participation Incentive
Incentive prizes were allocated to the RAC services with the highest percentage of staff completing the
survey per staff category each staff category to encourage individual and facility participation.
CELC-T1
• Category 1 - 2 Palliative Care Nurse Australia Nurse Grant (valued over $1500 each)
• Category 2 - 2 x $50 Coles voucher
• Category 3 - 2 x $50 Coles voucher
CELC-T2
• Category 1 - registration for one person to attend the Palliative Care in Queensland Annual Summit
and Awards Dinner and Good Life Good Death Expo in Brisbane 2nd and 3rd December 2018. The
prize includes economy airfares and one-night accommodation in Brisbane for the event. (Valued
over $1000)
• Category 2 - $50 Coles Voucher for the team.
• Category 3 - $50 Coles Voucher for the team.
Survey confidentiality
Palliative Care Queensland regards the confidentiality of the survey data to be of utmost importance.
Data from each of the participating RAC facilities was collected on paper-based surveys and entered
SurveyMonkey by the Project Coordinator. No personal identifiable information is presented in this report.
Additionally, the responses are combined and summarised in a report to further protect the anonymity of
participants.
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CELC-T TNA Key Findings
The findings have been presented in line with the five Training Needs Areas
• Training Needs Area 1 results: Current knowledge about palliative and end of life care3
• Training Needs Area 2 results: Their confidence in supporting and caring of palliative or end-of-life
care resident4
• Training Needs Area 3 results: Awareness of state-wide and national palliative care resources5
• Training Needs Area 4 results: Identification of challenges and barriers in providing excellent
palliative care in aged care during after-hours
• Training Needs Area 5 results: Training interest and modality preference
Both CELC-T1 and CELC-T2 shared similar findings and therefore the results were combined in this report.
3 Note: results collected only from the CELC-T2 All staff survey for this training needs area
4 Note: results collected only from the CELC-T2 All staff survey for this training needs area
5 Note: results collected only from the CELC-T2 All staff survey for this training needs area
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Training Needs Area 1 results: Current knowledge about palliative and end-of-life care
This question aimed at gaining an understanding of what participants feel palliative care means. All answers
provided could be considered correct (other than don’t know).
This question asked participants to rate their current knowledge about palliative care and end-of-life-care.
Most respondents (59%) indicated their current knowledge of palliative care and end-of-life care is good/
excellent. As expected, Category 1 rated their knowledge as higher than category 2 and 3. 6% of Category
2 and 13% of Category 3 staff indicated their knowledge was poor to extremely poor. The project team
recommends that the PDP focus support and education needs to all categories and ensure that category 3
staff are included as well.
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Training Needs Area 2 results: Their confidence in supporting and caring of palliative or end-of-life care residents
The purpose of this question was to determine how confident participants feel about having discussions with
residents or their families about life and death.
In all three categories the majority of staff rated their confidence level as reasonable.
As expected, Category 1 rated their confidence as higher than category 2 and 3. However considering that
the majority of their residents will have palliative care needs while living in the facility the project team
recommended a focus on communication techniques be integrated into the PDP to improve confidence in this
specific area.
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Training Needs Area 3 results: Awareness of state-wide and national palliative care resources
This question aimed at identifying the percentage of category 1 and 2 staff who have accessed specific
palliative care resources. The awareness of existing resources was lower than the project team expected,
therefore PDP resource kits promoting linkages to existing resources was recommended.
Note: This question was only asked in the CELC-T2 survey.
This question was aimed at Category 1 staff members to gain an understanding of their confidence levels in
relation to their knowledge of advance care planning and associated documents.
77% of respondents indicated they are reasonably confident/very confident in their knowledge of advance
care planning and associated documents. While the project team were impressed to see that no respondents
indicated they did not know what advance care planning was, 18% indicated they were not confident,
therefore as advance care planning would be considered a core role for category 1 staff our preference would
be to see this rated higher.
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The purpose of this question was to gain an understanding of what specific advance care documents/labels
Category 2 and 3 staff are aware of. As expected, Category 2 staff had a greater awareness of specific advance
care documents than Category 3 staff. However, the overall awareness of these documents are lower than
expected, therefore PDP resource kits promoting linkages to existing resources was recommended.
Note: This question was only asked in the CELC-T2 survey.
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Training Needs Area 4 results: Identification of challenges and barriers in providing excellent palliative care in aged care during after-hours
Barriers included lack of staff knowledge and confidence to care for the deteriorating resident. This is at odds
with the feedback from staff when asked to measure knowledge and confidence.
All staff survey results:
Main barriers in the provision of providing excellent palliative care in aged care during afterhours
Category 1 Staff Category 2 Staff Category 3 Staff
• Lack of staffing
• Knowledge and Confidence
• Communication - between GP, Families, staff
• Clarity surrounding roles - who does what
• Lack of education
• GP knowledge of palliative care
• Access to after-hours support
• Lack of hospice
• GPs willing to write palliative medicines orders
• Poor symptom management
• Unclear expectations - goals of care unclear
• Staffing – limited skill and knowledge
• Staffing – not enough
• Funding
• Symptom management
• Access to training/education
• Access to resources – specialist services/general practitioners
• Consumables for cares
• Catering for resident individuality – interests, beliefs, cultural background
• Communication – not be notified if resident dies
• Appropriate accommodation – for privacy
• Supporting residents who don’t have family
• Admin staff have no training in this area
• Quiet and comfort for resident and family
• Being respectful of care recipient and family.
• Being able to let family know we are here to help in all ways possible and they can be safe to ask.
• Having enough trained staff
• To be able to suit everybody’s needs and best care also accommodation to people’s beliefs
• Family may prefer hospital
• Funding
• Training and education for staff and caregivers
• Integration of palliative approach across settings/continuity of care
“Family demanding resident to be sent to hospital. Staff not knowing how to explain to families. Difficulty contacting GP for adequate pain relief.” – Category 1 staff
It should be noted that many responses across all staff categories indicated that residents were admitted to
hospital admissions because of family requests, prior advance care planning decisions and a lack of knowledge.
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Top identified reasons as to why palliative/end-of-life residents are transferred to hospital afterhours
Category 1 and 2 Category 3
Advance Care Plan - Requested in APR Lack of knowledge
Education – staff, resident and family Request by family
Distressed family Improved comfort
Decline in health (assessment) More resources available including access to doctors
Hospital better - More pain relief, a comfortable area Challenges accessing after-hours support
Symptom management - Pain management
Skill mix after-hours – not as many staff available
after-hours
Facility managers identified barriers and gaps in relation to the provision of palliative care to
residents after hours are:
• Lack of resources
• Lack of consistency with staffing
• Difficulty cementing ongoing skills or career path in this area
• Inadequate staffing resources e.g. hard to care for resident that requires 1:1
• Lack of regular staff, high turnover
• Restrictions on calls after-hours/lack of access
• Friction with hospital when families want to send resident to hospital and unable to convince them
otherwise
• Family who want to do different to the ACP
• Lack of collaborations from GPs
• Lack of skilled RNs,
• Lack of access to medications after hours
General responses across all categories suggest a perception by staff and families that hospital transfer of
the resident will equate to better comfort care and symptom management afterhours as staff have identified
there are challenges in accessing afterhours support. Another identified reason as to why residents are
transferred to hospital afterhours is due to family distress and by the request of the family.
FM Questionnaire results
The main barriers and gaps to providing palliative care to residents afterhours is due to a lack of resources,
inadequate staffing, lack of afterhours support, lack of access to medications and family who want a different
plan to the ACP.
“Planning ahead and getting orders in place during the day - especially before the weekend. If we are at a point and can't get what we need afterhours support, we transfer to hospital. The things that we need is education - some of our RNs are very junior look for education for them and AINs and personal care workers PCW” – Facility Manager
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Training Needs Area 5 results: Training interest and modality preference
The All staff survey results:
Identified interested training topics
Category 1 Category 2 Category 3
1. Breaking bad news
2. Communication skills
3. Medication management of symptom
4. Palliative care in general
5. Advance Care Planning
6. Recognising dying
7. Palliative Care – law and ethics
8. Case conferencing
1. Grief and bereavement
2. Palliative care in general
3. Advance Care Planning
4. Communicating with relatives and families
5. Coping with death and dying
6. Hands on experience
7. Allied health role in palliative care
8. Understanding the dying process
9. Self-care
10. Supporting families
1. Breaking bad news
2. Communication skills
3. Understanding my role in the team supporting resident and family
4. To be able to access palliative care training in general
Preferred learning style – all categories:
Participants were asked to identify their preferred learning style to receive palliative care education to help
develop education delivery strategies. 41% of respondents indicated on average, the top four preferred
learning styles to receive palliative care education are by: computer or iPad leaning modules (30%), face-to-
face (62%), practical skills workshop (39%) and attending a conference or workshop off-site (32%).
Note: This question was only asked in the CELC-T2 survey.
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Scheduling of training
Of the staff who responded to this question, 50% identified that they would be happy to attend palliative care
training if it was scheduled during work time. 14% of staff stated their preference would be for palliative care
training before or after work. Reasons identified included that they would be less likely to have distraction if
training was held offsite.
FM Questionnaire results:
The Facility Managers identified four recommended training structures for future education sessions:
• Face to face workshops
• Webinars
• Onsite training - short timeslots no longer than 2 hours in duration
• Online modules
CELC-T2 FM7 identified face-to-face training and online modules are the recommended training structures.
Face-to-face training was recommended but only for short 30-minute training sessions due to the facility’s
inability to cover for a large amount of staff for a long period of time. Online modules were recommended due
to the online training can be done in the staff’s own time or scheduled before or after their shift.
Facility managers also recommended using relatable case studies as a methodology to engage staff.
7 Note: This question was only asked in the CELC-T2 FM Questionnaire.
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Summary of CELC-T TNA key findings in relation to the five training needs areas
Five training needs areas Summary of Results
Training Needs Area 1: Current knowledge about palliative and end of life care
The self-rating of current knowledge for category
1 and 2 was relatively high compared to category
3 staff who indicated they have just ‘moderate’
current knowledge. However, other questions
indicated that there are gaps in knowledge about
what palliative care means.
It is recommended that the PDP focus support
and education needs to be targeted to all staff
categories.
Training Needs Area 2: Their confidence in supporting and caring of palliative or end-of-life- care residents
Across all 3 staff categories, most staff from
category 1 and 2 are reasonably confident in
having discussions about end of life with patient
and their families. It is recommended that a focus
on communication techniques be integrated into
the PDP education to improve confidence in this
specific area.
Training Needs Area 3: Awareness of state-wide and national palliative care resources
Multiple barriers were identified by staff and facility
managers including system level issues, training
needs and operational issues. This was found to be
at odds with the feedback from staff when asked to
measure their confidence and current knowledge.
Training Needs Area 4: Identification of challenges and barriers in providing excellent palliative care in aged care during after-hours
Multiple barriers were identified by staff and facility
managers including system level issues, training
needs and operational issues. This was found to be
at odds with the feedback from staff when asked to
measure their confidence and current knowledge.
Training Needs Area 5: Training interest and modality preference
To promote learning, multimodal trainings methods
are recommended and the inclusion of case
studies as a learning technique. Majority of staff
indicated they were interested in more training
in communication techniques, understanding the
dying process and Advance Care Planning.
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COMMUNITY SURVEY
Connecting Systems | Activity 2:
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Purpose of the Townsville Community Survey
The purpose of this community focused survey was to explore
Townsville’s:
• Public knowledge about palliative care
• To gain an understanding about how the Townsville public
are accessing and sharing information about palliative care
• Promote awareness of palliative care
Townsville Community Survey Development
The Townsville Community Survey Report was open from 14th February 2018 to 2nd April 2018 and
compromised a range of activities designed to maximize opportunities for community to participate. Activities
particularly focused on social media promotion and an incentive prize to complete the survey.
The Community survey questions were adapted from five different surveys:
1. Queen’s university Belfast: Exploring public awareness and perceptions of palliative care: a
qualitative study (2014)
2. Powell River Hospice Society and Powell River Division of Family Practice: Palliative Care
Community Survey (2017)
3. Hospice New Zealand: Public perceptions of hospice and palliative care and attitudes to death and
dying survey (2010)
4. Scottish Partnerships for Palliative Care: Public awareness of palliative care (2018)
5. Palliative Care Australia website community survey poll (2018)
Key findings of the Townsville Community Survey
A total of 337 completed the survey and survey promotion had a reach of over 6,500 on social media.
Key findings of the survey included
• 70% respondent indicated that they are ‘not very confident’ about accessing information and
support about palliative care and end of life issues.
• 68% respondents indicated that don’t feel confident in having conversation about palliative care
• 60% indicated they learned about palliative care through their personal experience and the next
highest response was through friends, families and coworkers.
• 82% respondents would choose quality of life over length of life.
In addition, ‘Grey feedback’ received from social media engagement indicated that health professional’s
explanations and approach to end of life care were not always understood by community members.
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Four key recommendations were identified as part of the Townsville Community Survey
1. Increase community confidence to source quality palliative care information
2. Increase community confidence in facilitating conversations about end of life
3. Improve health professional’s ability to explain the process of end of life care
4. Share patient experiences and stories about end of life
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TOWNSVILLE PALLIATIVE CARE SERVICES AND
SUPPORTS MAPPING AND DIRECTORY
Connecting Systems | Activity 3:
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Purpose of the Townsville Palliative Care services and support mapping and Directory
The Townsville Palliative Care Services and Support mapping and Directory
was developed as a result from the TNA and community survey due to many
people stating they were not aware and did not know about community
resources and how to access them.
Methodology
In 2017 – 2018 Palliative Care Queensland undertook a community
services and supporting mapping activity within the Greater Townsville
Region to identify a variety of services and supports available for people
with palliative needs. This mapping also included services and supports that
exhibited at the Townsville Good Life Good Death expo.
Service mapping ensures that services are not being duplicated and available services are known - particularly
after-hours and community-based non-government organisation[NGO] services. Service mapping also
stimulates conversations about palliative care as the underlying question is “do you provide any supports for
people experiencing loss, ageing, dying and grief?” Many services underestimate what they do in this space
and this service mapping activity has enabled them to validate any supports they currently provide or what
they are considering providing in the future.
The CELC-T Steering committee recommended that the directory be held within mycommunitydirectory, an
online tool which is already being utilised by other NQPHN projects and many local councils in Queensland.
Once the mapping was completed Palliative Care QLD worked with mycommunitydirectory to create a
centralised source of information where community members in Townsville can find all support services
available and what services they provide.
Key findings of the Townsville Palliative Care Services and Supports Mapping and Community Directory
A total of 45 services and supports were identified within the Greater Townsville region and provided to
mycommunitydirectory. These are now available in the live search function on their website and app.
A Townsville Palliative Care Services and Supports Directory PDF is also available to download from the
mycommunitydirectory website – this is updated every time a service or support updates their contact details
therefore is very useful for General Practice and RACs.
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PALLIATIVE CARE IN AGED CARE ROUND
TABLE
Connecting Systems | Activity 4:
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Purpose of the Townsville Palliative Care in Aged Care Round Table
The purpose of the Palliative Care in Aged Care Round Table meeting was to
facilitate an informal discussion surrounding the current model of palliative
care service delivery in RAC – specifically the 10 facilities captured in the
CELC-T project. The Palliative Care in Aged Care Round Table was an invite-
only event, it provided the opportunity for local stakeholders to discuss
challenges, opportunities and vision for a sustainable model of Palliative Care
in Aged Care in Townsville.
Methodology
The event was held on 29 June 2018 and was attended by 21 out of 22 attendees who formally invited including:
• Local members of the Townsville Community [Consumers, Clinical Leaders from Acute, Specialist
Palliative Care, RAC, PHN, General Practice, Legal]
• Palliative Care Queensland
• Palliative Care Australia
• Council Of The Ageing Queensland (COTA Qld)
• Canberra Hospital and Health Services
Key findings of the Townsville Palliative Care in Aged Care Round Table
Top key issues identified
• Lack of clarity of PC RAC vision Townsville
• Symptom management - availability of skilled staff to deliver breakthrough medications during night
• Lack of skilled workforce
• Limited GP support afterhours – lack of continuity of care
• Poor communication with consumers and families about transition to palliative care
• Goals of care and Advance Care Planning documentation – inconsistency with documentation being
accepted e.g. ARP
• ED staff challenged with recognizing dying
• Inappropriate referrals to ED | hospital afterhours
• Aboriginal and Torres Strait Islander representative not apparent
10 opportunities identified
• Develop local strategy network to ensure sustain conversations and facilitate change
• Facilitate Consumer engagement – Consumer Round table with all RACFs inviting residents and families
• Goals of Care | Advanced Care Planning – discussions with RACF public and RACF private to have
consistent documentation – work with QAS to identify issues
• Training focus in communication and compassion – embed training needs orientation and
appraisal systems.
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• Ensure General Palliative Care is on the agenda at every DON/F< RACF Townsville Meeting
• Paramedics and QAS – Opportunity for linkages/pathways between LARU, Specialist Palliative Care
services and RACF
• Understanding dying pathways – strengths & room for improvements: recognized with case reviews
/death audits attended by Acute/Specialist/RACF staff
• Mapping of GP services & Pharmacy services to RACF – particularly in afterhours
• Recognising dying – clinical and consumer awareness of how to recognise and communicate dying
needs using appropriate common language
• Investigate Nurse Practitioner led Model – case management/case conferencing, linkage between
RACF & Hospital, mentorship and trainings
Round Table follow up activities
Following the Palliative Care in Aged Care Round Table four follow up meetings were held monthly with the
executive/directors from NQPHN, Townsville Hospital Palliative Care Team and Palliative Care Queensland.
The Ten opportunities were discussed at each of these meetings to ensure they were followed up or
embedded into other activities existing within the different organisations.
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CONNECTING PRACTICE
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PRACTICE DEVELOPMENT PROGRAM
Connecting Practice | Activity 5:
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Purpose of the Practice Development Program [PDP]
The Practice Development Program (PDP) was developed in response to the findings of the TNA to address
the training needs of the RAC services staff in the Townsville HHS region.
The purpose of the PDP was focused on:
• Improving staff knowledge about quality palliative care and confidence to deliver quality palliative care
• Reducing perception of barriers
• Build linkages to existing resources
PDP methodology
Target audience
The PDP are collaborative sessions targeted at Palliative Care services in the Townsville HHS region, North
Queensland Primary Health Network, GPs, Practice Nurses, Allied Health, QAS and aged care providers to
deliver education and training systems.
Promotion
The CELC-T PDP was promoted through various strategies, this included
• Social media posts via Facebook and Twitter;
• NQPHN communications team;
• PCQ eNews;
• CELC-T Steering Committee networks;
• Direct emails and telephone contact with key contact persons for each RACF e.g. Director of Care,
facility/quality manager, educator.
• As an incentive to encourage attendance of RAC staff at each site a complimentary copy of the
Australian Pain Society: Pain in Residential Aged Care: Management strategies book [valued at
$100] to any RAC who sent 2 or more staff members to a session. This process was consistent across
all CELC project sites
PDP implementation
The PDP was implemented through various delivery modes such as: webinars, workshops, education
mornings and resource folders. The content of the workshops was flexible to enable maximum participation of
staff from all levels and experience.
Webinars
The five topics included in the webinars were discussed with the CELC-T project The Committee based on the
results of the TNA.
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The topics included were:
• PCC4U: Free Palliative Care online education resources
• Communication skills, underpinning palliative care
• Talking about grief and loss
• After bad news has been broken – how to continue the conversation
• Compassion underpinning your care – for yourself and others
The webinars were developed based on the recommendations from the
TNA and discussion with The Committee members. Therefore, it was
recommended that the webinars be made to address the education needs,
provide opportunities to discuss case studies and to work collaboratively
with professional stakeholders.
Where possible, webinars were recorded. Copies of these sessions will be available for participants via PCQ
website. Several RAC services and GPs provided feedback relating to challenges accessing webinars because
of unreliable technology.
Workshops
The PDP workshops consisted of five 2-hour workshops and were hosted at various locations in the
Townsville HHS region, including Eventide Nursing Home Charters Towers and NQ PHN Townsville over
three days [21/03/19 - 22/03/19, 02/04/19]. The workshops were designed to be face-to-face participative
groups to address educational needs based from the TNA results and with The Committee’s input.
The topics included in the workshops were:
• Identifying complex residents at high risk for requiring after-hours support
• Identifying goals of care for people with palliative needs
• Symptom management for people with palliative needs
• Understanding your role in the team when caring for people with palliative needs
• Palliative care is everybody’s business – What is palliative care?
A total of 58 participants attended the PDP workshops across the 3 days. 48 participants provided evaluation
feedback, giving a response rate of 83%.
Morning education sessions
The Education breakfast sessions are designed to be a collaborative education morning open to all Palliative
Care Queensland members, palliative care (Primary care, aged care, general practice, disability sector and
acute hospital staff) and specialist palliative care health professionals as well as anyone with an interest in
palliative care in Queensland. The sessions are included: a panel of speakers discussing the topics based on
their experience in relation to the topic. The topics were chosen based on the World Health Organisation’s
definition of palliative care and the results from the TNA.
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Where possible, webinars were recorded. Copies of these sessions will be available for participants via PCQ
website. Several RAC services and GPs provided feedback relating to challenges accessing webinars because
of unreliable technology.
Evaluations
Participants were given an evaluation form to provide feedback about the session they attended.
This form came in two methods:
1. a scanned PDF evaluation form where participants filled out the form and emailed it back or
2. a paper-based evaluation form where a PCQ Officer gave the form to the participant and
collected it after.
The results of the evaluation are found in the next section.
Limitations
The process of capturing written evaluations for the education events conducted via model of webinars was
difficult to achieve. Despite best efforts of sending PDF and electronic links to feedback forms, return rates
are not optimal.
CELC-T PDP results
The PDP results are presented in line with the four purposes of the PDP
1. Improving staff knowledge about quality palliative care and confidence to deliver quality
palliative care
a. There was a 44% positive shift in the knowledge rating pre and post the PDP activities – from
a 49% pre (good/excellent) to a 93% post.
b. There was a 45% positive shift in the confidence rating pre and post the PDP activities – from
a 47% pre (good/excellent) to a 92% post.
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2) Reducing perception of barriers
A key focus underpinning all the PDP activities was to discuss the barriers identified in the TNA and
encourage the participants to explore their own methods of overcoming these. Some of these were captured
in the evaluation survey when they were asked what changes they would make post the PDP activity:
• Provide more palliative care education and resources for all staff
• Support teams/staff involved with palliative care
• Debrief more often
• Improve relationships with allied health and GPs
• Start conversations
3) Build linkages to existing resources
Resource folders were provided at all face-to-face PDP activities. These provided linkages to existing
resources and were highlighted throughout the PDP activities as well.
PDP participants shared some key take home messages:
• There are resources available
• Communication with everyone involved is important – including family
• Early planning of end-of-life care is needed
• Everyone has role in end-of-life-care
• Palliative care is not giving up
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I CARE FOR MY RESIDENTS WITH PALLIATIVE NEEDS
RESOURCE KIT
Connecting Practice | Activity 6:
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Purpose of the ICARE for my residents with palliative care needs resource kit
The ICARE for my residents with palliative care needs resource kit, was an extension to the PDP resource
kit which aimed to link services to existing resources and provide guidance for planning for afterhours
palliative care needs.
A new resource was developed in conjunction with all the CELC-NQ projects (CELC-M, CELC–C and CELC-T)
which was referred to as the 5 elements of ICARE for my residents with palliative needs framework. It aimed to
provide a practical decision-making framework to assist staff when caring for a resident with palliative care
needs and avoid unnecessary transfer to acute care facilities after-hours.
The 5 elements include:
1. Identify the goals of care
2. Clarify your role in the care plan
3. Anticipate and plan for symptoms
4. Review the care plan regularly
5. Equip yourself with knowledge
Methodology
The ICARE for my residents resource kit has evolved from comments we received from the training needs
analysis [TNA] conducted with residential aged care [RAC] staff in the Mackay HHS, Townsville HHS and
Cairns HHS. Staff identified the need for ready access to information and support about:
• Palliative care and symptom management,
• Communication with residents/family, team members and other service providers,
• Advance care planning
• Where to gain practical hands on experience with other services providing palliative care
• Supporting residents and family with grief and loss
The items in the ICARE for my residents resource kit include National Projects identified resources such as:
a. Resource folders – to access extra information
• Policy and strategy information
• Resource links & flyers for palliative statewide/national projects
• PCC4U information including a USB stick – links to self-directed learning modules
• Caring for Aboriginal and Torres Strait Islander peoples
• Advance Care Planning & Communication resources
b. Lanyard cards
c. Posters
• iCARE for my residents with palliative needs 5 elements poster
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• iCARE for my residents with palliative needs comic poster
• CELC-NQ Equip yourself knowledge
d. palliAGED Practice Tips booklets
• palliAGED Practice Tips for Care workers from Aged Care
• palliAGED Practice Tips for Nurses in Aged Care
ICARE for my residents resource kit distribution summary
The ICARE for my residents resource kit was distributed by courier mail [pack and send] to 9 facilities in Mackay
HHS region. Upon delivery/collection of the ICARE for my residents resource kit, a signature by the facility’s
collector was requested to indicate the resource kit was received. One RAC declined to receive the ICARE for my resident with palliative needs resource kit.”
Preliminary evaluation
As the resource kits were provided in the last month of the project, the evaluation is only considered
preliminary.
A total of 11 out of 19 RAC services in the Townsville HHS region provided feedback on the ICARE for my residents with palliative needs resources kit with a response rate of 58%.
• 4 out of 11 (36%) RAC services provided comments stating the ICARE resource kit is very helpful
and useful with one facility stating they are planning on ordering more resources from the ICARE r
esource kit for their staff
• 2 out of 11 (18%) RAC services have said they have shared the ICARE resource kit with their staff
• 4 RAC services have indicated they have not used the ICARE resource kit due to the resource kit left
in the clinical manager’s office who is currently away
• Other RAC services that have responded indicated that they have not had time to go through the
resources and have left the resource kit in an open staff area where staff can peruse through it (e.g.
staff room, medications rooms etc.)
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““Very good. Passing onto the Clinical Nurse when she comes back from leave”
““The information and brochures are very good and will be sure to use it”
““Put the box in the medication room for RN’s and EN’s to have a look at”
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CELC-NQ SPECIAL INTEREST GROUP
Connecting Practice | Activity 7:
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Purpose of the CELC-NQ Special Interest Group (CELC_NQ SIG)
The CELQ-NQ Special Interest Group is a 1-hour video conference that
runs bi-monthly. The purpose of the CELQ-NQ SIG is to keep an ongoing
connection up to date best practice, systems improvements and education
opportunities related to palliative care in aged care.
CELC-NQ SIG conversations will be held by webinar starting from 25 June
2019.
CELC-NQ SIG Methodology
The CELQ-NQ SIG topics were developed based from what health care
professionals [category 1] stated are a priority in relation to Palliative Care
from the TNA. These topics include:
• Palliative care and symptom management
• Communication with residents/family, team members and other service providers
• Advance care planning
• Supporting residents and family with grief and loss
• How do we help residents/clients decide ‘what matters most’ to them?
• Where to gain practical hands on experience with other services providing palliative care
• Palliative care emergencies
• Self-care and self-compassion: looking after yourself
The development of the dates and times were discussed with the CELC-M Steering Committee members and
feedback identified from the TNA. It was decided the video conferences will run bi-monthly from 2pm to
3pm during a non-busy period of the day. The regular meeting time bi-monthly will increase the potential for
clinical education to be embedded into usual practice.
The online mode of delivery will extend the opportunity for participation of staff working in regional and
rural facilities and increase linkages to other service providers. Discussion items will be centred around local
community priorities and issues raised by relevant stakeholders.
CELC-NQ SIG Implementation
The CELQ-NQ SIG will be available for interested clinicians within the NQPHN region to participate. In June
2019, flyers were distributed widely via email and post throughout Northern Queensland, particularly in
Cairns, Mackay and Townsville.
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CONNECTING COMMUNITY
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COMMUNITY ENGAGEMENT ACTIVITIES
Connecting Community | Activity 8:
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Purpose of the Connecting Community activities
The CELC-T project engaged with the community through a variety of methodologies enabled the project to
gain deep understanding of opportunities and challenges of community engagement within the framework of
palliative care.
Community Activities had three focuses:
• Community engagement – starting conversations around loss, ageing, dying and grief in an open,
honest and friendly environment, and to help people understand that end-of-life shouldn’t be
considered a taboo subject
• Information sharing – showcase services, supports and resources related to end-of-life in the form
of exhibition boots, presentations, discussions and handouts. TO facilitate networking opportunities
for local service providers, community organisations, groups and members.
• Education – to share information, stories and best-practice in relation to palliative end-of-life
through education sessions free for the community to attend with health professionals.
Community Activities
Activities included:
• Community Conversation Starter Activities
o Public Information Booths (i.e. shopping Centre booths and markets)
o Before I die banners
o Awareness campaigns – what matters most thought boards
• Participation in community events
o Chronic disease management expo – Townsville Aboriginal and Islander Health Services (TAIHS)
o NAIDOC Week
o Belgian School Parade
o Dying to Know day
o Queensland Palliative Care Film Night
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o James Cook University Marketing Day
o Mater Hospice Community Connect provider expo
o Community Aged Care Round Table
o Townsville City Council activities
o National Palliative Care Week – Light up the Townsville Bridge
Key findings of the CELC-T community activities
The project shared many learnings from participating in these community activities. Some of these included:
• Attendees would like to know more about Palliative Care and upcoming relative activities
• Statement of choice, and the PCA discussion starters were popular resources
• Free Henna tattoo provide an incentive to attracting people of all ages and inviting them to join our
conversation on palliative care and what matters most. While having henna, it provided an
opportunity to chat with the attendees and know about their perspective on palliative care
• The Before I Die banner is easy for people to engage with and prompts conversation starters
• Positive feedback from 1 GP, who could not gain permission to display the banner in their waiting
room, therefore displayed it in his consult room – he noted that this helped start conversations
about palliative care with his patients.
• School art competitions are an effective method to engage schools in conversations about caring and loss
• Local Councils are very supportive of community initiatives and compassionate communities
In general, people we engaged with, as part of our community activities, stated they had a:
• Greater level of understanding of the benefits of early conversations about health care choices and
understand who in the community can assist them to achieve their wishes at end-of-life.
• Better understanding of the benefits of palliative care and the positive impact it can have on
individuals and families in supporting people as they live with life-limiting illnesses.
• Increased confidence in starting discussions related to loss and dying.
““This made me think of palliative care completely differently – its makes me focused on what I want rather than what I don’t have anymore” Health student
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GOOD LIFE GOOD DEATH EXPO
Connecting Community | Activity 9:
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Townsville Good Life Good, Death Expo
Over 29-30 June 2018, Palliative Care Queensland held its inaugural North
Queensland Community Expo at the Ville Resort in Townsville. The expo was
titled Good Life Good Death expo [the Expo] in line with the inaugural Brisbane
2017 Expo and was considered a great success.
The free 2-day Good Life Good Death expo had over 400 attendees, 10
volunteers, 35 exhibitors and 20 expert speakers. Over 240 people attended the
educational sessions.
The purpose of the Townsville Good Life Good, Death Expo
Four key purposes for the Good Life Good Death expo were identified:
• Start conversations around loss, ageing, dying and grief in an open,
honest and friendly environment, to help people understand that end of
life shouldn’t be a taboo subject.
• Showcase services and resources related to end of life in the form of
exhibition booths, presentations, discussions and handouts.
• Facilitate networking opportunities for local service providers,
community organisations, groups and members.
• Share information, stories and best practice in relation to palliative and end of life through breakfast
sessions, a round table and expert panel sessions.
Results of the Townsville Good Life Good Death expo
There are 3 main aspects to the Expo:
• Community Aspect
• Exhibition and Information Aspect
• Education Aspect
Over 400 people attended the Good Life Good Death expo in Townsville.
• 47% Health Professional
• 53% Community Member
o Including 6% identifying as Carer and 2% identifying they have a palliative condition.
In total 35 exhibitors attended the Expo. These included local, Queensland and National Exhibitors.
• 100% of exhibitors said that they enjoyed the Expo
• 94% of respondents said that they would exhibit again and/or recommend the Expo to a friend or
colleague
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The Education aspect to the Expo was sponsored by the Connecting End of Life Care in Townsville project,
administered by Palliative Care Queensland and funded by Northern Queensland Primary Health Network.
• 61 people attended the Education Breakfasts
• 157 people attended the Expert Panel Sessions across the two days
By starting these conversations, sharing information and showcasing services and resources available the
outcomes we achieved was that all attendees:
• Had a greater level of understanding of the benefits of early conversations about health care choices
and understand who in the community can assist them to achieve their wishes at end of life.
• Had a better understanding of the benefits of palliative care and the positive impact it can have on
individuals and families in supporting people as they live with life-limiting illnesses.
• Had increased confidence in starting discussions related to death and dying.
100% of respondents who provided feedback told us that they enjoyed the Expo and the majority indicated
they would attend again.
““End of life is a big fact of life and it is being discussed in a very big way in Townsville”
Michael Clarke, ABC Radio North Queensland
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PROJECT RECOMMENDATIONS
FOR TOWNSVILLE
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The following are recommendations for the North Queensland Primary Health Network (NQPHN) in the Townsville HHS region:
• Consider extending the TNA and PDP into acute and community settings to improve understanding
and connections between and across sectors
• Evaluation of Special Interest Group impact on improving connections and conversations between
sectors to demystify service context and establish collegial respect for challenges and opportunities
to improve good day time planning for people with palliative care needs
• Continue the implementation of the ICARE for my resident resource kit and follow up on integration
• Continue to facilitate discussions between national projects to avoid duplication of activity and
increase awareness of sector need
• Provide regular/accessible education/information on general palliative care to ‘refresh’ on
knowledge and specific medication and alternative pain management strategies
• Encourage RAC services to provide training and support to staff regarding dealing with increased
pressure from families
• Encourage RAC services linking with innovative models of service to support clinical decision making
and mentorship
• Consider technology to support engagement with clinical support afterhours such as telehealth –
models that need further exploration and can demonstrate impact on outcomes for hospital avoidance
• Add community engagement into future palliative care projects within the region, to extend to
impact of the project and support for service providers and consumers
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DEFINITION AND ABBREVIATIONS
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Definition and Abbreviations
Abbreviation Definition
AIN Assistant in Nursing
The All staff survey All residential aged care staff training needs analysis focus questions
Category 1 staff RNs, ENs, Managers, Quality staff and Education staff
Category 2 staffAllied Health, Carer/Assistant in Nursing [AINs], Team Leaders, Activities Coordinators/Officers and Pastoral/Spiritual carers
Category 3 staffReception staff, cleaners and domestic staff, laundry staff and volunteers
CELCConnecting End of Life Care https://palliativecareqld.org.au/celc
CELC-C Connecting End of Live Care - Cairns
CELC-M Connecting End of Life Care - Mackay
CELC-NQConnecting End of Life Care - North Queensland Inclusive of CELC-T1, CELC-T2, CELC-M, CELC-C projects
CELC-TConnecting End of Life Care – Townsville (inclusive of CELC-T1 and CELC-T2 projects))
The Committee CELC-T Steering Committee
Connecting End of Life Care – Townsville 1 [CELC-T1]
First phase of the CELC-T project from April 2017 for 12-months
Connecting End of Life Care – Townsville 2 [CELC-T2]
Second phase of the CELC-T project from April 2018 for 12-months. Continuation of the CELC-T1 (first phase)
End-of-life-care [EOLC]
Includes physical, spiritual and psychosocial assessment, and care and treatment delivered by health professionals and ancillary staff. It also includes support of families and carers, and care of the patient’s body after their death. People are ‘approaching the end of life’ when they are likely to die within the next 12 months Source: Queensland Government - Care at the end of life: https://www.qld.gov.au/health/
support/end-of-life/care/palliative
The ExpoGood Life, Good Death expo
www.goodlifegooddeathexpo.org.au
Facility Manager [FM]The leadership role title of the positions varied with some identifying as Director of Nursing, some as facility managers
Abbreviation Definition
FM Questionnaire Facility manager training needs analysis focus group questions
GP General Practitioner
HHS Hospital and Health Service
NGO Non-government organisation
NQPHN Northern Queensland Primary health Network
Palliative Care
Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Source: World Health Organisation: https://www.who.int/cancer/palliative/definition/en/
PCQPalliative Care Queensland www.palliativecareqld.org.au
PCW Personal care worker
PDP Practice Development Program
RAC Residential Aged Care
SIG Special Interest Group
Specialist palliative care
Supports and educates the palliative care sector and provide specialist additional supports for people and their families who have complex and persistent issues related to their care. Source: Palliative Care Australia - Palliative Care Service Development Guidelines (2018)
- http://palliativecare.org.au/wp-content/uploads/dlm_ uploads/2018/02/PalliativeCare-
Service-Delivery-2018_web2.pdf
TNA Training Needs Analysis