Transforming end of life care using practice development: an arts-informed approach in residential aged care.

Purpose: To demonstrate that practice development is an effective strategy to enable an aged care team to embed a palliative approach to care of dying people into practice culture. Method: Practice development methodology was integrated with an action research evaluation framework, as a systematic and reflexive process of inquiry aimed at achieving innovative and transformative end of life care. Drawing on multiple sources of observational, group and interview data, evidence-based guidelines and the use of arts-informed active learning methods, a multidisciplinary aged care team explored personal and professional values and beliefs about principles of care delivery. These were creatively translated into meaningful expressions of evidence-informed end of life care and embedded into daily clinical practice. Results: Reflexive analysis of multiple sources of data, alongside the use of evidence-based guidelines, supported the collaborative development of a 'palliative care chest of drawers' (PCCOD). As an artefact and one outcome of using practice development in the implementation of a palliative approach to care, the PCCOD brought visible, shared meanings and new ways of working to support care of people who are dying, their families, other facility residents and staff. The PCCOD enabled the aged care team to embed practice innovations into normative patterns of care. Conclusion: Practice development strategies are effective in enabling practitioner-led innovation in clinical practice through integrated inquiry and transformative processes. Implications for practice: The use of a practice development, arts-informed approach: • Enables the creation of space for workbased learning and innovation, such as the development and use of the PCCOD to support the process of implementation of changes in practice • Makes visible changes to practice, based on shared meanings of a palliative approach to end of life care that reflects the culture of the workplace • Provides a creative strategic tool to engage others in the processes of transformation and collaboration, which takes initiatives from a small active learning group into the workplace • Enables what was previously a 'hidden' part of care to be a distinctive care package that engages residents, families and all members of the aged care team. [ABSTRACT FROM AUTHOR]