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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.
The reality for some time in respect to continuing to provide quality health care is “Work smarter not harder”. The health dollar is becoming like a Northern White Rhinoceros , still in existence but rare. There is ever increasing scrutiny about how both of these prized possessions are used and treated. Continued investment is regularly linked to reportable outcomes, whether it be in the case of the Rhinoceros an increase in their numbers or for the health dollar reduced overall cost. You are more likely these days to find the CEO of a hospital having an MBA in hospital administration than being a senior clinician. As this is a reality we need to develop strategies / programmes that do have clinically reportable outcomes that they will comprehend.
Aileen Collier is a lecturer in Palliative and Supportive Services, Flinders University. Her research sits at the interface of social science and health research and is focused on human agency and safety and quality of palliative care. She also teaches in the Flinders University post-graduate program.
What advice can I offer you about nursing, research and improving health care? Nurses, as the backbone of our health services, need to be highly responsive to direct patient care needs. If improvements in palliative care are to be realised however, we also need to enact what colleagues Jane Phillips and Meera Agar have recently described as “exemplary leadership”. Our health care systems are complex, in constant flux and driven by efficiency and cost effectiveness. We need to take an active role in policy development as well as critically adapting ‘top-down’ policy and evidence-based initiatives within local settings. In this environment, nurses simply cannot afford not to be able to make sense of research findings.