What is a Multidisciplinary Team (MDT) in community aged care?
A group of professionals from different disciplines working together to provide coordinated, holistic care for older adults.
What are the main goals of an MDT in community aged care?
Promote independence and quality of life, prevent hospital admissions/readmissions, support safe and continuous person-centred care, and assist/educate carers and families.
Who are some common MDT members?
GP, nurse, physiotherapist, occupational therapist, dietician, speech pathologist, podiatrist, social worker, psychologist, pharmacist, case manager, support worker.
How does an MDT typically work?
Through regular team meetings, shared care plans, collaborative decision-making, with the client/family central to all care decisions.
What is Advance Care Planning (ACP)?
A process for discussing and documenting a person’s healthcare preferences in case they lose decision-making capacity.
What is the purpose of ACP?
Respects autonomy and dignity, improves communication, guides healthcare professionals, and provides peace of mind for families.
What is an Advance Care Directive (ACD)?
A document stating treatment preferences and the nominated decision-maker.
What is the Enduring Power of Attorney in ACP?
A legal substitute decision-maker for healthcare decisions.
Give examples of preferences documented in ACP.
Life-sustaining treatments (CPR, ventilation), preferred place of care (home, hospital, hospice), spiritual/cultural needs, comfort or palliative focus.
What is the nurse’s role in ACP?
Support and initiate discussions early, document preferences, and share across care teams.
What is a carer?
Someone who provides unpaid support to an older person or someone with illness or disability.
What are common physical stressors for carers?
Fatigue and strain from care tasks, e.g., pain and exhaustion.
What are common emotional stressors for carers?
Guilt, anxiety, grief, burnout, and depression.
What are common social stressors for carers?
Reduced social contact, isolation, and loneliness.
What are common financial stressors for carers?
Lost income, extra costs, debt, and stress.
What is role strain for carers?
Balancing multiple roles, leading to loss of self-identity.
How does uncertainty affect carers?
Worry about future care, chronic anxiety.
What happens when carers have a lack of support?
Few respite options, leading to burnout.
What are health impacts of caring stress?
Increased stress, fatigue, poor sleep, hypertension, depression, and neglect of own health.
What support services are available for carers?
Respite services, support groups, education/training.
What is the nursing/community role regarding carers?
Acknowledge carers as part of the team, assess wellbeing, provide info, encourage self-care and respite.
