In my role managing two aged care homes in Melbourne, I have come across a number of challenges which needed to be overcome. I took over one home four and a half years ago and the second 18 months ago, discovering the same basic issues in each home; after the first time, the issues were relatively easy to change. Staff were fractured in the sense that departments did not necessarily rely on each other and work together, and knowledge of clinical issues was only handed over to clinical staff, not to the whole home (not an unusual happening). My idea of sharing with all staff was greeted with a degree of scepticism at first, but staff embraced it quite quickly and then started to discuss things across different departments. They had also not been introduced to The Residential Aged Care Palliative Approach Toolkit, which I made a mandatory competency, including staff from non-clinical areas who wanted to be involved. This is still being rolled out to all new staff. Quite a number of staff have been to external education sessions which has then made speaking with colleagues, residents, and relatives much easier. It is also imperative that staff not only have the right equipment, but the right training on the equipment!
The need to build and maintain a cohesive team is one of the most important parts of managing an aged care home and is particularly applicable when residents are in palliative care. The team in itself presents many challenges because of the range of experience and knowledge, age, culture, beliefs, and languages among the staff, which then translates into potentially even more challenges when residents and relatives are added, especially when emotions come into play and personalities take over. Conflict and dispute management have played a large part of my role in several end-of-life scenes, but are not necessary when residents, relatives, and staff have been prepared with as much information and education as possible. The aged care manager/DON must constantly strive to balance these factors when planning, rostering, and managing the home on a daily basis, particularly when residents become palliative.
We managers must maintain the highest possible standards in practice by being aware of the latest best practice and then ensuring that this is passed on to all levels and areas of staff and other stakeholders by positive practice and education. Guidance, consultation, and reassurance for relatives is an important role for management staff, who should also enlist the assistance of external providers as needed. Brochures, posters, etc, in appropriate languages may make both staff and relatives easier about end-of-life care.
Mandatory education, using the Palliative Care Toolkit, etc, is a useful tool, but should be followed up regularly by discussion and encouragement for staff to undertake further education. Once staff have agreed to do this, meetings and discussions need to be held so that their experiences and knowledge are shared with other staff and used to care for residents. I believe that managers should be the first to complete any education and should always be on the lookout for further tools relevant to Australian nurses and carers. Debriefing to discuss positive and negative aspects of the end-of-life care given can improve practice and team work. It is imperative that all managers understand the importance and relevance of the input of non-clinical staff and also relatives and friends.