Rehabilitative palliative care in practice

Examples of innovation and good practice in rehabilitative palliative care.

Nurse-led rehabilitative model of respite care

St Joseph’s Hospice offers nurse-led respite support for patients booked for planned respite stays of one to two weeks, in seven dedicated respite beds. At admission, each patient has a comprehensive assessment to establish their personal goals and priorities and to create a programme of support tailored to reflect these. For the patient this may relate to maximising functionality, promoting independence, advance care planning, review of medical, nursing and medication needs and reflecting on current socialisation opportunities. For the carer, this may relate to coping abilities and future needs.

How rehabilitative palliative care is delivered in daily practice on the respite unit:

  • Approach to care is enabling, assessing what can be done and what may be retrievable (eg if loss of function is evident) with a focus on doing ‘with’ the patient, as opposed ‘to’ the patient.
  • All support and supervision recognises the importance of independence and actively creates opportunities to optimise this.
  • Collaborative multidisciplinary approach to supporting patients’ goals, with early recognition of need and proactive referral to members of the multidisciplinary teamfor input.
  • Multidisciplinary team meetings and handovers focus on identifying and optimising patients’ potential, and include carers as the expert voice of care.
  • ‘My day’ document used to record patients’ normal routines and support these to be maintained when the patient is unable to communicate effectively with the team.
  • Respite environment supports social interaction and normal routines.
  • Repetition and reiteration of the emphasis and approach of rehabilitative care.

How this model best supports patients’ and carers’ needs and priorities:

  • Promotes and delivers choice to patients – ensuring they have options.
  • Supports patients to maintain their normal routines or allows change in a safe environment. Patients actively encouraged to exert control and structure over their day.
  • Patients are supported to adopt self-management techniques in their daily activities including self medication.
  • Patients are encouraged to integrate and socialise with other patients, carers, staff and volunteers in line with their wishes, eg communal eating, activities, current issues discussion.
  • Empowers patients through setting and achieving their own goals – preparing them to proactively manage their health upon return home.

Diane Laverty, Nurse Consultant, St Joseph’s Hospice

Debbie Pegram, Respite Ward Manager, St Joseph’s Hospice

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