Nurses caring for older people near the end of life are now able to access up to the minute clinical advice at the point of care, thanks to the development of a new smartphone app.
Available free through Google Play and the Apple Store, the app – known as palliAGEDnurse – has been developed as part of the Decisions Assist program for aged care staff in residential and home care settings.
It provides easy to use clinical advice based around three key areas – advance care planning, case conferencing, and terminal care.
The app was developed by the CareSearch Project Team at Flinders University, following the production last year of the palliAGED app for General Practitioners (GPs).
Interest in the first app has been strong, with 2,880 downloads of the app by the end of March 2016. Data from the app site where its content is held indicates there have been more than 1,000 visits to the palliAGED site each month - more than 30 visits a day.
Suite of two palliAGED apps
The positive response from GPs to the palliAGED app has led Decision Assist to produce a second app - this time for nurses, with the two apps now being marketed through both app stores as a suite – one for GPs and one for nurses.
The new app caters for Australia’s large residential aged care workforce with 13,939 Registered Nurses, 10,999 Enrolled Nurses, and 64,669 Personal Care Assistants (these figures are based on full time equivalent, FTE). It is also designed for the community care workforce where there are 6,544 Registered Nurses, 2, 345 Enrolled Nurses, and 41,394 Personal Care Assistants, FTE.
CareSearch Director, A/Professor Jennifer Tieman, identifies the impetus behind the development of the app as twofold.
“With the rapidly expanding knowledge base for clinical practice it can be challenging for health professionals - including nurses - to keep their knowledge and skills up to date,’’ she says.
“While continuing professional development (CPD) is an important professional responsibility to invest in new skills and knowledge, nurses also need to be able to access knowledge at the point of care, that is, where they practice.
“Web based resources are helpful for this, and the growing use of apps prompted Decision Assist to explore different ways to share clinical knowledge and encourage its use in practice.”
The locations in which nurses are providing care to older people are increasingly varied, which raises the need for portable and up-to-date resources for nurses to consult at the point of care.
For example, increasingly older people are enabled to live at home through the provision of Australian Government home care packages and many are spending some or all of the last year of their life at home. Nurses will therefore need to be able to recognise and address their palliative care needs.
Some older people move to residential aged care, others live with families or friends, while some may spend time in hospital. Nearly all will be involved with a GP and through his/her general practice, they may engage with a Practice Nurse.
Whatever the location for care, nurses usually need similar information, as well as some setting-specific ideas which are provided through the app.
A palliative care approach
Being able to recognise that some older patients may die within the next 12 months is an opportunity for nurses to plan for changing care needs. However, not all have the skills to identify a changing trajectory or the confidence to deliver a palliative approach to care.
This approach supports quality of life by planning and addressing needs as they arise. It focuses on three core clinical processes:
- Advance care planning to know the person’s wishes
- Palliative case conferencing as things change to make sure everyone is “on the same page” about what is likely to happen in the coming months and how to best manage the specific needs of the individual
- A terminal care plan for the last days of life to make sure symptoms are managed and other issues alleviated, such as distress.
“Thanks Karen for the resources. I have also found the palliAGED (the Decision Assist) app very handy, have been encouraging aged care staff and GPs to consider downloading it as well”.
LinkedIn comment, Nurse Practitioner, March 2016
So what’s in palliAGEDnurse?
Based on the palliative care approach, the palliAGEDnurse app provides the following four key sections:
- Understanding a palliative approach (and identifying older people needing a palliative approach)
- Advance care planning
- Palliative care case conference
- Terminal care planning.
App keeps up to date and works anywhere
CareSearch has designed the app to constantly update the advice that it gives nurse users.
A/Professor Tieman says being web based, the app goes to the website - where new evidence is published - to read its content. This content can also be viewed on a computer or a tablet.
‘’This means that you don’t have to use the app to access the information if you don’t have a smartphone or if your smartphone is a bit older and does not work with some of the new standards. The linked website has a responsive design, which means you can just view it on your phone screen and the presentation will adjust for your type of device,’’ said A/Professor Tieman.
When nurses download the app, the content will work as app users expect, such as swiping to move between pages, and menu bars rather than fixed menus.
“One valuable addition has been developing a solution that enables you to still have a version of the app if you go out of internet range. In the past, this would generally mean that the app dropped out and couldn’t be viewed until you were back connected to the internet. Now, we have enabled a solution that holds a version locally in the phone, so if you go out of internet range, the app still works. And if something changed while you out of range, when you come back it will automatically update,’’ said A/Professor Tieman.
“It wasn't the website itself, but the Decision Assist App. It was a clinical situation in which it was obvious to those caring for the patient that the situation was palliative. The GP was wanting to admit the patient to hospital to manage high potassium levels, which was inappropriate in a palliative setting. By showing the GP the app those first questions in "Assessing your older patients" the surprise question "would you be surprised if your patient died in the next 6-12 months" was enough to prompt the GP to re-think and enable good palliative management. I would have no hesitation in utilising the Decision Assist website to assist in seeking advice to manage a palliative situation”.
Expert advice and development processes
CareSearch began its research about apps for GPs and nurses by searching what other apps were available worldwide. It found there were many, but most were not sufficiently complete or targeted to meet the needs of Australian GP and nurses. For more information on this research go to: www.caresearch.com.au/caresearch/TabId/3781/ArtMID/6000/ArticleID/19/Have-you-ever-wondered-why-its-difficult-to-find-a-useful-and-relevant-palliative-care-app-when-you-need-one.aspx
To develop an app for Australian needs, the palliAGEDnurse app was directly overseen by the GATI Advisory Group, which is a group of experts from medicine, nursing, pharmacy and academia.
The initial content was derived from aged care education workshops in the Decision Assist Program. This was then reviewed by a specifically constituted group of nurses from primary care, residential aged care, community aged care, palliative care and university nursing staff. The comments and proposed changes from the palliAGEDnurse Review Group were then summarised and reviewed by the GATI Advisory Group.
The content was then uploaded into the app platform and assessed again by the two groups in terms of its usability, with a final review by the GATI Advisory Group prior to its release into the app stores. To download the palliAGEDnurse app, go direct to Google Play or the App Store here.
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