Debbie WhiteNurse Practitioner Palliative Care

Port Macquarie Community Health Campus

October 2013

Community Innovation:

The Development of a Nurse Practitioner Model of Care

in Palliative Care

Purpose

Explore model of care and the NP role

To share a narrative of my experience

Illustrate the highlights and challenges along the way

Demonstrate the benefits for the patients and families

Model of Care

A way of working

A multidimensional concept that describes how health services are delivered (QLD Govt 2000)

Encompasses: patient centred, safe, effective, equitable, quality, efficient, cost effective, innovative care (NSW Health 2005, WA Govt 2008)

Ensuring right care, right time, right place

Nurse Practitioner

“A registered nurse who is educated and endorsed

to function autonomously and collaboratively in an

advanced and extended clinical role…”

Assessment & management skills

Referral, prescribing medications, ordering diagnostic investigations

The role is grounded in nursing – values, theories, knowledge

Provides innovative and flexible health care delivery that complements other health care providers

Safety & Quality Framework for NP’s

Nurse Practitioners in Palliative Care

Standards for Palliative Care (PCA) – NP listed as part of specialist level services

In NSW there are 5 NP’s and 1-2 Transitional NP’s in place

A valuable addition to the Palliative Care MDT

Palliative Care

For people with a life limiting illness

Multidisciplinary approach

Cares for the patient and family

Impeccable assessment and early treatment of symptoms

Holistic approach: physical, spiritual, cultural, emotional

(WHO 2005)

Palliative Care in NSW

In rural / regional NSW → 1.6 fte Palliative Care Specialists

High chronic disease burden

– 10% of patients with chronic disease receive palliative care

– 66% of cancer patients receive palliative care

Flexible, innovative approaches to meet the demand and provide a sustainable service

The Journey…..

The Beginning…. Role commenced in 2011

Hastings Macleay Clinical Network

Community based role– Home

– Wauchope PCU

– Residential Aged Care

– Kempsey Hospital

– Nurse Led Clinic

Clinical, Education, Leadership, Research

Finding ‘my place’

An additional position for an already established team

– Skilled Clinicians

Transitioning from CNC to NP

– Different responsibilities

– New CNC role developing

In the team, or an extension of the team?

Challenges…..

Doctors and NP’s

MBS Number

Lack of understanding of the role

Covering a large geographical area

No Palliative Care Specialist

Developing a new role

– support systems

– Structure

– expectations

Data 54 weeks

612 OoS (n of patients 150 – 160)

Referrals n =160

Malignant 65% Non-Malignant 20% Unknown 15%

Consults ?

P/U PCT GP RACF Direct Hosp

40 31 7 9 35 38

25% 19% 5% 6% 22% 24%

An Evolving Role…… Learning, researching, waiting

Changing expectations without changing beliefs and values

Working with the team – challenging ways of working

Introducing innovation, identifying gaps

Collecting data

Expanding own scope of practice

A Model of Care….

The biggest lesson or realisation..

The role is still very new despite recent progress at state and national level

Questions…