Case scenarios

1. Issue

General practitioners (GPs) in a large regional practice want to ensure the practice team is well-skilled and confident to deliver palliative care for their local community.

2. Using the Framework

The practice manager coordinates a meeting of all staff (doctors, practice nurses, administration staff).

• Working through the Framework together to examine current knowledge and gaps, the group determines further education and training regarding general palliative care provision is not required at this time.
• As the practice services a significant cohort of Aboriginal people, the team identify the need for education and training to improve the provision of culturally respectful and appropriate palliative care services for Aboriginal people.

3. Relevant learning items

Models of care:

• 1.1.3. Models of care delivery for Aboriginal people

Strategic planning and service development:

• 3.2.5. Consumer partnerships with special needs groups in service development

Communication:

• 1.3.1.Developing communication skills in end-of-life and palliative care through training in the needs of Aboriginal people

Impeccable assessment:

• 2.1.1. Holistic palliative care assessment including spiritual and cultural needs (of Aboriginal people)

Care planning:

• 2.2.1. Holistic care planning which considers cultural and spiritual needs (of Aboriginal people)

Prevention and relief of suffering:

• 2.3.1. Considers the person and the family/carer to ensure the plan of care encompasses cultural and spiritual needs

Loss, grief and bereavement:

• 2.5.5. Cultural views on death, grief and bereavement
• 2.5.8. Psychosocial and spiritual needs of individuals and groups

4. Next steps…

Using the resources linked to the Framework, the practice manager identifies a suitable education event in the Palliative and Supportive Care Education (PaSCE) program provided by the Program of Experience in the Palliative Approach (PEPA); Cultured Centred Palliative Care – an Aboriginal perspective.

She and one of the practice GPs attend the two-day training course with the intention of using the information gained to run an in-service for the practice staff and identify areas for the practice to address.

1. Issue

A senior physician approaches the Director of Medical Education expressing concern about the decisions that some interns are making in relation to the management of patients approaching the end-of-life.

One intern chose to prescribe a large dose of sedative to a patient dying with pancreatic cancer.

Another initiates intravenous fluids at the end-of-life for all patients who are unable to swallow, and a third has disclosed information to a family member without the patient's permission.

The physician suggests that interactive education regarding ethical decision-making in palliative care be made available to the current cohort of interns.

2. Using the Framework

The Medical Education Department reviews the Framework learning items under learning focus 1.4. ethics and decision-making against the relevant undergraduate medical curricula. Previous learning is identified and any gaps in knowledge and skills are identified.

3. Relevant learning items

Ethics and decision-making

• 1.4.1. Own beliefs and values and how these effect decision-making and influence practice.
• 1.4.5. Using ethical principles and frameworks in practice.
• 1.4.6. Participating in ethical decision-making in end-of-life care.
• 1.4.7. Interpreting and applying legislation in end-of-life care.

4. Next steps

The Medical Education Department develops a new in-house education module for interns on ethics and decision-making in end-of-life and palliative care.

The module is delivered via a multimodal approach including dedicated workshops, departmental teaching on end-of-life and palliative care from senior clinicians and clinical discussions during mortality and morbidity meetings.

Existing resources linked to the Framework including the End of Life Law for Clinicians training program are included within the module.

1. Issue

A large disability service provider (group homes, community support and therapy service) identifies the need for increasing service capacity in the provision of palliative care to their clients.

2. Using the Framework

The executive team brings together a group of senior service managers from within the organisation to discuss the issue and consider the actions required to achieve organisational change.

Workforce education and training are identified as components that will be required in the development of enhanced palliative care services.

At a second meeting, the education and training coordinator uses the Framework to determine that the existing level of palliative care knowledge and skills varies considerably across the group of senior managers.

3. Relevant learning items

Strategic planning and service development:

• 3.2.1. Historical development of end-of-life and palliative care and implications for service models
• 3.2.8. Contemporary end-of-life and palliative care

Models of care:

• 1.1.13. Partnerships with others, organisations/services to improve palliative and end-of-life care

Communication:

• 1.3.2. Communication during care transitions
• 1.3.5. Facilitating team communication

Ethics and decision-making:

• 1.4.5. Using ethical principles and frameworks in practice
• 1.4.7. Interpreting and applying legislation on end-of-life care

Assessment:

• 2.1.8. Equipping the team to respond to the assessment needs of the person, family/carer

Care planning and clinical practice:

• 2.2.1. Holistic care planning

Loss, grief and bereavement:

• 2.5.1. Contemporary concepts in loss, grief and bereavement, ‘normal’ and ‘complicated’ grief 2.5.6. Grief and bereavement services and resources

4. Next steps...

Due to the breadth of variation in senior service manager knowledge and skills it is determined that select managers will attend a general palliative care education session accessed via the Palliative and Supportive Care Education (PaSCE) Service, provided by the Program of Experience in the Palliative Approach (PEPA) – Palliative care for Health Professionals working in Disability Services.

Now familiar with the Framework, senior managers use the tool to determine education and training needs within their service specific teams and identify appropriate education and training.

1. Issue

The manager of a large residential aged care facility has conducted an audit of residents' records, of those who have died over the past 12 months. She has noted that despite an expressed wish of 90% of residents to die at the facility, only 23% did.

The audit results are tabled at the facility monthly staff meeting. Feedback from staff including nursing, allied health and personal care staff indicates a lack of confidence in identifying clinical deterioration, coordinating and delivering care during transition to and during the terminal phase.

2. Using the Framework

The manager determines that focussed learning incorporating advance care planning and establishing goals of care will be used to improve staff confidence in this area of service provision.

She uses the Framework to identify the current skills and knowledge level of staff, determining that expertise varies considerably across the different staff groups i.e. registered nurses (RNs), allied health and personal care staff.

3. Relevant learning items

For RNs:

Models of care:

• 1.1.2. Contemporary palliative care

Ethics and decision-making:

• 1.4.1. Own beliefs and values and how these affect decision-making and influence practice
• 1.4.7. Interpreting and applying legislation in end-of-life care

Impeccable assessment:

• 2.1.6. Applying palliative care assessment during increasing decline and in the last days of life

Clinical management:

• 2.2.4. Care planning during increasing decline and last days of life including the Care Plan for the Dying Person
• 2.2.9. Rapid response to changing and escalating needs

Prevention and relief of suffering:

• 2.3.2. Preventing, recognising and responding to holistic suffering

Loss, grief and bereavement:

• 2.5.16. Providing bereavement services

4. Next steps…

The manager determines education and training for registered nurses to be a priority in the first instance.

Using the resources linked to the Framework, she identifies suitable training sessions accessed via the Palliative and Supportive Care Education (PaSCE) Service: Principles of Palliative Care, Modules 1 and 2.

The RNs will be involved in the development and delivery of future informal in-house education to allied health and personal care staff.

1. Issue

The new Medical Director, Renal Services comes to the position with extensive experience in renal care, having had a variety of senior roles in her specialty.

This is her first position in senior management. In addition to her usual responsibilities within the renal specialty she is now also responsible for developing a new advanced renal palliative care symptom clinic which is run by her department.

The medical director is keen for the renal palliative care clinic to be a success and is aware that members of the team have limited palliative care experience.

2. Using the Framework

The medical director brings together a group of senior clinicians to discuss strategies for development of the new clinic.

Together they discuss their learning needs. Using the Framework, they determine the priority to be education and training for senior staff in palliative care service planning and development.

3. Relevant learning items

Strategic planning and service development

• 3.2.17. Building sustainable quality health services
• 3.2.20. Conducting and analysing health service needs assessment

• 3.2.21. Involvement in outcome measure collaborations and use of data in service improvement
• 3.2.25. Leading and managing change within the health service and across health care

Workforce development and succession planning

• 3.4.7. Creating and sustaining a culture that supports education and training in palliative care
• 3.4.10. Attracting and retaining specialist palliative care staff.

4. Next steps…

The medical director accesses the education and training required by senior managers from a number of sources including the Health Service Leadership and Management in-service program and directly from palliative care physicians.

Formal clinical mentoring is planned, resourced and implemented. Formal evaluation is supported by data.

Using the resources linked to the Framework, senior clinicians also access the Palliative Care Outcomes Collaboration (PCOC) Essentials Program and Clinical Leadership Workshops.

In further development of the clinic, the Framework will be used to determine the education and training required for other clinical staff within the service.

1. Issue

The family of a 7-year-old child who is at end-of-life and currently receiving specialist palliative care in a metropolitan tertiary hospital, wants to return to their home in a regional location, to be close to family and their community.

The local allied health team (physiotherapist, dietitian, social worker), who predominately care for adults, have not had experience in caring for a child at end-of-life with palliative care needs. They recognise they would benefit from paediatric palliative care education and request support from the Specialist Palliative Care Service at the tertiary hospital.

2. Using the Framework

The local allied health team express concerns regarding their current level of knowledge and experience around communication with the child and siblings, such as how to respond to questions if the child or sibling ask about death and dying and identifying the allied health needs of the child, e.g. the child’s feeding needs and equipment that may be required.

The local allied health team, with input from the Specialist Paediatric Palliative Care Service, work through the Framework to identify current knowledge and skills, gaps in knowledge/skills and learning needs.

3. Relevant learning items

Models of contemporary care:

• 1.1.1. Person, carer and family-centred care
• 1.1.2. Models of contemporary palliative care including paediatric (perinatal – adolescent)
• 1.1.4. Integrative care and care partnerships

Communication:

• 1.3.1. Developing communication skills in end-of-life and palliative care including in challenging situations with, individuals, children, siblings, families and/or carers and colleagues and developmental and age-specific communication

Impeccable assessment:

• 2.1.1. Holistic palliative care assessment of the person including developmental assessment
• 2.1.2. Use of evidence-based, standardised clinical assessment tools and methods

Pre-emptive care planning and clinical practice:

• 2.2.1. Holistic care planning which considers person, family/siblings/carer(s)

Prevention and relief of suffering:

• 2.3.1. Preventing, recognising and responding to holistic suffering including differing perspectives (person, family/carer(s), team, staff) and impact on family and community

Loss, grief and bereavement:

• 2.5.1. Contemporary concepts in loss, grief, bereavement, mourning and trauma
• 2.5.4. Communication about loss, grief and bereavement
• 2.5.5. Recognition of own experiences, values and beliefs about end-of-life choices, death, dying and grieving

4. Next steps…

The education is delivered as a combination of face-to-face sessions with the Regional Palliative Care team and via relevant online learning resources linked to the Framework including the End-of-life Essentials Education Module – Paediatric end-of-life care and the PCC4U learning modules, focus topic 1, Caring for children with a life-limiting illness.