Improved Experiences of Care: A Pilot of a Nurse Practitioner Led Model

Introduction: End-of-life care in the home setting can be challenging, particularly in regional or rural areas. The need to travel for care and scant resources especially after hours make admission to hospital more likely when crises arise. Careful care planning, however, can reduce this risk when utilising a multidisciplinary approach that includes the GP, nursing service providers, and specialist palliative care input. In this pilot, specialist care was provided by a Palliative Care Nurse Practitioner based in a local residential aged care facility, who facilitated care planning through case conferencing, anticipated symptom management and family support needs, and responded to out-of-hours contact from carers.

Aim: This presentation focuses on the experiences of patients and carers who received support at home from this NP-led model.

Method: semi-structured in-depth interviews were conducted with patient-carer dyads at baseline assessment prior to case conferencing, and again one month later where possible. Inductive thematic analysis by two researchers enabled exploration of the participants' experiences of receiving care through this model.

Findings: The significant impact of illness and providing care was mitigated when timely access to, and coordination of, services was in place. Both patients and carers showed limited understanding of the model but reported increased confidence to remain at home. Being located in regional and rural settings reduced the availability of specialist care but the palliative care NP provided much of this input in this pilot.

Conclusion: this NP-led model of home care was associated with improved patient and carer experiences of end of life care. It was resource-intensive and further consideration of sustainable models of this approach is indicated.

Improved Experiences of Care: A Pilot of a Nurse Practitioner Led Model (658kb pdf)