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Community Home Based Palliative Care Service |
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| CLINICAL MODEL PRINCIPLES |
The uniqueness of each client is central to care provision and guides care
planning to ensure it is timely, person-centred and respects individual
wishes and needs.
Care is provided according to health promotion principles optimising and
enhancing community relationships such as family, friends and significant
others.
Care is based on collaborative partnerships with primary care providers
strengthening relationships and minimising duplication.
People will be admitted/re-admitted and discharged as appropriate to their
individual need.
Care Coordinators are accountable for continuity and coordination of the
care plan.
Although not all people will require the services of all team members
interdisciplinary communication ensures the changing care needs be met
by the most appropriate team members.
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The process of care includes: prioritising of referrals, timely ongoing
assessment, coordination of the interdisciplinary team and appropriate
discharge and referral to other health or community service providers.
The physical, psychological, social, spiritual and emotional needs of the
clients are central to the assessment and care planning process
Advance Care Plan discussions are encouraged in order to allow client to
articulate their values preferences and choices to facilitate a good death.
An innovative loss and grief programme is available to all clients and their
carers.
The safety of clients, staff and volunteers in the community setting is
facilitated by clear communication and compliance with Occupational
Health & Safety policies.
Mandatory clinical supervision for all clinical staff and volunteers
facilitates professional practice, nurtures professional development and
promotes self care.
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