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The views and opinions expressed in our blog series are those of the authors and are not necessarily supported by CareSearch, Flinders University and/or the Australian Government Department of Health.
There is no doubt that nurses are fundamental to health care. There are over 350,000 nurses currently practising in Australia. They are the largest single health profession in Australia. But more importantly, they are most often the face of care to the person needing care. And this is particularly important to remember when thinking about the care needs of an older person who may be the last stage of their life.
Many older people spend some or all of the last year of their life at home. Some will move to residential aged care or will already be in an aged care facility. Others will live with families or friends. Some may spend time in a hospital. Nearly all will be involved with a GP and with their Practice Nurses. So not only are nurses critical in enabling good care for older Australians coming to the end of their life, they will be providing this care in many different settings.
We all know that the population is ageing; and the figures forecasted are significant with around 15% (3.6 million people) older than 65 years in 2016 (Australian Bureau of Statistics (ABS), 2013). These figures will continue to soar, and by 2031 it is estimated 19% (5.7 million) of the population will be older than 65 years (ABS, 2013).
In 2015 it was reported that 75% of people aged 65 and over who died in Australia used an aged care service in the 12 months before their death, and 60% were an aged care client at the time of their death (AIHW, 2015). These figures alone point out the obvious key role the aged care sector plays in ensuring a person’s quality of life reaches its maximum potential as they approach the end of their lives, and inherent within that is the role aged care plays in ensuring a good death.
Nurse Practitioners (NP) work in many roles in residential aged care: general primary care, wound care, memory disorders, mental health, heart failure and palliative care.
A Nurse Practitioner is a Registered Nurse who has completed both advanced university study at a Masters Degree level and extensive clinical training to expand upon the traditional role of a Registered Nurse. They use extended skills, knowledge and experience in the assessment, planning, implementation, diagnosis and evaluation of care required.
As far as I know, I am still (unfortunately) the only specialist palliative care nurse practitioner employed by an aged care provider in Australia. Why is that you ask? Primarily it comes down to money. NP services are not funded via the aged care funding system (ACFI), and the income I can generate from bulk billing residents via Medicare covers only a small proportion of my salary. So it relies on an organisation like Resthaven seeing the non-monetary benefits and improved outcomes that stem from a role like this.
In 2013, Canalys (1) estimated there were over 1,600,000 apps available in the two largest online app stores, iTunes and Google Play, and the number of platform-based, service carrier or manufacturer-operated online stores has increased to over 70 worldwide in the last two years (2). With over 1.2 billion people now accessing mobile applications (3), the role of the app has become multidimensional, with users expecting to discover an app to enhance every part of their life, for both work and play. For healthcare professionals (HCPs) working in palliative care, searching, evaluating, identifying, and downloading relevant apps from the proverbial sea of applications is a time-consuming pastime which often yields little to no results.
Chronic breathlessness is highly prevalent across the community. One in 100 Australians have significant impairment of their activities of daily living and one in 300 people are housebound because of breathlessness.
Chronic breathlessness is systematically under-recognised by health professionals. When taking a history about breathlessness, the question ‘are you breathless?’ is not going to elicit the problem nor its magnitude. ‘What do you have to avoid in order to minimise breathlessness?’ is a far more important question, or this can also be phrased as ‘what have you given up in order not to be breathless?’ With these questions, we start to get a picture of the net impact of breathlessness on individual patients.