Residential aged-care workers and the palliative approach: Tensions in the field

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. © 2009 Lippincott Williams & Wilkins, Inc.