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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.
Let’s be frank, end-of-life care can be tricky. Yes, dying is normal, but it hasn’t been a major focus in the acute hospital systems. Health care professionals working in acute hospitals can find themselves challenged by patients with end-of-life care needs. Doctors, nurses and allied health professionals can be in a situation where they do not know how to best respond to a patient with end-of-life needs. Appropriate end-of-life interventions can be missed.
With 52% of Australians dying in acute hospitals, end-of-life care is essential knowledge for all health care professionals.
I remember a patient some years ago. I’ll call her Maria. She was a lovely Italian woman, in her late 80’s, with a very supportive family.
Maria had developed very complex medical problems. She had heart issues, kidney problems and quite severe diabetes. In the last year of her life she had recurring kidney failure and breathing difficulties. She was going in and out of hospital every three or four weeks.
The medical team did their very best for her – they were very focused on her medical issues and her symptoms, and she received excellent medical care. A lot of focus was given to how best to look after her kidneys, her heart, her pain and her difficulty with breathing. As her problems multiplied and her needs became increasingly complex, the care she received continued to be excellent.
Reflecting on what I do and what my responsibilities are as a Research Nurse is quite complex and one single role cannot encompass all the activities associated with clinical research trials.
Protocol development is the first phase of the project, where a team is involved in developing the protocol. From my perspective, knowledge and experience of a research nurse is indispensable in creating a good balance between the needs of the research and the patients involved.
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.
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.