Sonia Allen

The implications of policy on delivering a palliative approach in residential aged care: Rhetoric or reality?

Abstract This critical ethnographic study aimed to understand policy and documentation in relationship to guiding nursing practice in delivering a palliative approach to residents of an aged care unit of a Multi-purpose Service (MPS). A thematic analysis was undertaken that searched the text for cultural determinants of practice, and similarities and differences between the data sets. Where discrepancies occurred, key informants were revisited and questioned regarding anomalies. Using a critical lens this interpreted data formed the substantive findings of this research. The Guidelines for a Palliative Approach in Residential Aged Care (RAC) were not known or understood by management or nurses employed in this MPS. This paper supports the need for research to be conducted into evaluating the Guidelines as the current premise of this research is that policy is rhetoric not reality in providing a planned trajectory of care for residents and their family members.

Examining the methods used for a critical ethnographic enquiry.

Methodology articulates the broad theoretical and philosophical framework which researchers employ when conducting an inquiry. Methods are the procedural rules by which research inquiry is conducted; giving authority to articulate and communicate information as reliable and accurate in nature. Critical ethnography delves beneath the surface to examine the power relations and influences affecting phenomena by using field methods to identify not only culture, the ‘consciousness’ or the ‘lived experiences’ of others, but also exposing the political, social and material disempowerment of individuals and disadvantaged groups in order to elicit change. Fieldwork is central to all ethnographies and in this critical ethnography it forms the platform from which the delivery of palliative care to aged residents in a multi-purpose centre can be scrutinised. This paper explicates the fieldwork adopted in conducting such a study.

Discourses associated with nursing aged people who are dying in the Australian context: a review of the literature

AIM To examine the discourses associated with nursing care of aged people who are dying in the Australian context. BACKGROUND The discourses associated with nursing aged people who are dying are not universally understood, and there is confusion regarding the meaning of terminology used to describe specific nursing practices in the aged care setting in Australia. METHODS A literature search was undertaken to identify nursing practices and the discourses associated with nursing aged people who are dying in the Australian context. Words used in the literature to describe practices related to nursing care of the dying were distilled, and a search of the Cummulative Index to Nursing and Allied Health Literature (CINAHL) database using this vocabulary was undertaken to explicate the meanings associated with specific terminology. FINDINGS The review of literature highlighted a plethora of nursing practices related to caring for people who are aged and dying. Hospice care, palliative care, terminal care, end-of-life care and a palliative approach are terms used to describe specific practices associated with nursing people who are dying. These terms have distinct meanings; however, they are often used interchangeably in aged care settings adding to confusion and the potential for compromised nursing practice standards. IMPLICATIONS FOR PRACTICE Understanding the terminology associated with nursing practice provided to people who are aged and dying allows the profession to engage in dialogue that is universally understood. Dialogue allows for rigorous debate, research and ultimately the evolution of nursing practice, improved outcomes for this group and the avoidance of unnecessary legal challenge to individual and institutional practice standards. CONCLUSION The terminology associated with the provision of care to the aged who are dying is reflective of the broader healthcare discourse focused on dying and death. Shared agreement about this terminology will avoid unnecessary litigation resulting from misunderstanding of the discourses that describe and define practice and enhance health outcomes for the aged dying and their families and/or significant others.

Gaining human ethics approval: a strategy for refining research studies

AbstractWe argue that developing a human ethics application is an effective method for refining the intent and design of research studies. Our study aimed to investigate the delivery of end-of-life and palliative care nursing to residents of an aged care unit in a Multi-purpose Service/Centre in rural Victoria. We used the ethics application process as a strategy to focus the study, and to refine the data collection and analysis techniques. It is our contention that the process of completing the application and gaining ethics approval is laborious; however, the intellectualising that occurs provides researchers with an opportunity to reflect upon and refine their studies, thus ensuring the ultimate success and timely completion of research investigations.