Table 4 Relationships between the standards, objectives, and interventions in the NUHELP program

Objective 1: To conduct a comprehensive assessment and develop a personalized care plan adapted to the palliative needs detected.

Standards on which this objective is based:

• People approaching the end of life are offered comprehensive assessments in response to their changing needs and preferences.

• A personalized care plan for people approaching the end of life which is appropriate to their needs and preferences is developed and reviewed.

-Palliative care needs are identified.

-A comprehensive geriatric and palliative care assessment is conducted.

-A personalized care plan is created and adapted to the palliative care needs identified.

Objective 2: To provide information in a clear and accessible way.

Standards on which this objective is based:

• The professionals on the team ask the patient and family members how they would like to be informed about the diagnosis/prognosis/treatment progress of the disease and reflect this in the clinical record in a clearly visible place.

• People approaching the end of life receive communication and information in an accessible and sensitive way in response to their needs and preferences.

• The team provides information on the benefits and adverse effects of the treatments that may be provided to the patient.

• The team enables the patient to be involved in decision-making throughout the course of the disease.

-The information that the

patient and/or family have regarding the patient’s clinical status is ascertained.

-The patient’s preferences regarding the information they wish to receive are explored.

-The family’s preferences regarding the information provided to them and to the patient are explored when there is no secrecy surrounding the patient’s health.*

-The family’s preferences regarding the information provided to them and to the patient are explored when there is secrecy surrounding the patient’s health.*

-The patient and/or family are informed

about clinical matters.

Objective 3: To request and record advance care directives.

Standards on which this objective is based:

• There is an advance care directive document in place.

• The team enables the patient to be involved in decision-making throughout the course of the disease.

-The existence of documents

stating the patient’s preferences is verified.

-The patient’s preferences regarding

decision-making are assessed

(patients without

cognitive impairment).*

-Information is provided on what advance care directives are and what their purpose is.

-The advance care directive document is discussed with the patient and/or family. +

-The advance care directive document is filled out. +

-The decisions made are reported

to primary care workers and to the members of the healthcare team at the nursing home. +

Objective 4: To provide early care with respect to loss and grief.

Standards on which this objective is based:

• Families of the deceased are offered emotional and spiritual support appropriate to their needs and preferences during the grieving process.

• Families of the deceased are offered emotional and spiritual support appropriate to their needs and preferences during the grieving process.

-Family involvement in the patient’s care is encouraged.

-Communication between the resident and the family is encouraged.

-Risk factors for complicated grief are identified and addressed.

-The patient’s spiritual needs are valued.*

Objective 5: To refer patients to a specialized palliative care unit if appropriate, depending on the complexity of the palliative care required.

Standards on which this objective is based:

• The clinical material and medication needed to carry out care work are available to staff.

• Patient referral criteria are clearly defined.

• People approaching the end of life who may benefit from specialist palliative care are offered this care in a timely manner appropriate to their needs and preferences, at any time of day or night.

• People approaching the end of life who experience a crisis at any time of day or night receive prompt, safe, and effective urgent care appropriate to their needs and preferences.

-The nursing home has established priority levels for the provision of specialist palliative care resources.

-Priority for providing these resources is established based on residents’ palliative care needs and on complex and highly complex palliative care aspects.

-There is a procedure in place to request the provision of specialist palliative care resources.

-The interventions and care recommended by the support team are provided and the situation is re-assessed whenever necessary or recommended.

*Depending on the presence or absence of cognitive impairment.

+Depending on whether they wish to proceed.