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Residential Aged-Care Workers and the Palliative Approach: Tensions in the Field

McInerney, Fran PhD; Ford, Rosemary PhD; Simpson, Angela Grad. Dip. Psychology; Willison, Michelle Grad. Dip. Health Admin.

Journal of Hospice & Palliative Nursing: November-December 2009 - Volume 11 - Issue 6 - p 344-352
doi: 10.1097/NJH.0b013e3181bd03df

Despite the recognition of the importance of the palliative approach for older adults in residential aged-care facilities, the provision of palliative care remains suboptimal. Strategies to improve palliative care education have targeted those health carers who provide direct physical care, namely, registered nurses and unlicensed personal care attendants. While ancillary (laundry, lifestyle, food services, maintenance, and administrative) staff have been identified as an important part of the aged-care team, they have been largely absent from such studies. This article reports the experiences and perceptions of palliative care by the entire care team in an Australian aged-care facility. With few exceptions, staff perceived palliative care to be synonymous with terminal care and to be primarily physically focused. Teamwork was found to be threatened by poor communication strategies between physical care and ancillary staff, with ancillary staff simultaneously reluctant to engage in, and frustrated by their exclusion from, care-related discussions. In addition to identifying key areas for education for all levels of health carers, along with the potential of focus groups as a strategy in this endeavor, this study highlights the importance of team cohesion for enacting the palliative approach in the aged-care context.

Author Affiliations: Fran McInerney, PhD, is Associate Professor, Aged Care, School of Nursing and Midwifery, Australian Catholic University, Fitzroy; and Associate Professor, Catholic Homes, Victoria, Australia.

Rosemary Ford, PhD, is Senior Lecturer, School of Nursing and Midwifery, Australian Catholic University, Fitzroy, Australia.

Angela Simpson, Grad. Dip. Psychology, is Research Assistant, School of Nursing and Midwifery, Australian Catholic University, Fitzroy, Australia.

Michelle Willison, Grad. Dip. Health Admin., is Residential Services Manager, Catholic Homes, Victoria, Australia.

This project was supported by an Australian Catholic University Faculty of Health Sciences research grant.

Data from this study were presented at Palliative Care Victoria's 6th Biennial State Conference: Palliative Care Beyond the Boundaries, Melbourne, Australia, October 2008.

Address correspondence to Fran McInerney, PhD, Joint Appointment Catholic Homes/ACU National, School of Nursing and Midwifery, Faculty of Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, Melbourne, Victoria 3065, Australia (

© 2009 The Hospice and Palliative Nurses Association