Smiling Nurse

Nursing and Palliative Care in Numbers

 

As the largest group of health care professionals in Australia, nurses have a major role in supporting the demand for palliative care across all age groups including the increasing number of older Australians approaching the end of life with chronic conditions. 

The World Health Organization (WHO) has marked the birth of Florence Nightingale 200 years ago by designating 2020 the International Year of the Nurse and the Midwife.

Well known for her holistic approach to care, Florence Nightingale was also at the forefront of medical care reform through data collection and statistics. An early adopter of infographics to effectively communicate complex information to diverse audiences she also understood the importance of communication. Skills that remain highly relevant today.

In recognition of 2020 as the year of nursing here we highlight the Australian College of Nursing (ACN) review of evidence underpinning the value of nursing services for people with life-limiting conditions. [1] We also pay homage to Florence Nightingale as we briefly examine what Australian data sources tell us about the nursing workforce and the demand for palliative care.

Workforce

The ACN review noted that: [ref 1] '…there is a large nursing workforce providing palliative care on a day-to-day basis in contexts such as chronic disease management, aged care, or general medical care. These nurses are often not considered ‘specialists’ in palliative care, yet they provide essential nursing services and require appropriate knowledge, competence and skills to ensure they deliver key elements of quality palliative care. Other nurses practice in purpose-designed specialised palliative care unites in hospitals or the community and require an advanced level of knowledge and skill.'

Examination of the evidence showed that Nurse-led models of palliative care mostly provided by nurses working in advanced practice roles deliver statistically significant benefits for patients, services or the health system. [1]  Key components of effective models were:

  • symptom management,
  • goals of care discussions,
  • patient education, and
  • care coordination.

From this we understand that nurses skilled in palliative care are needed in all settings and those with advanced training provide needed leadership to implement effective models of care. As the demand for palliative care increases it will be important to ensure that current and next generation nurses are trained and supported to develop skills in symptom management, communication and care coordination, and to take up advanced practice roles.

 

What the numbers tell us:

The number of employed nurses and midwives, and number of enrolled student nurses both increased between 2013 and 2017. But where those increases are happening varies across the community. Substantial increases in the number of nurse practitioners with advanced training are encouraging as are the increases in general practice nurses. Growth in palliative care nurses is more moderate.

 

Demand for palliative care

The ACN review notes that ‘The demand for palliative care, which is responsive to these complex needs, is likely to increase with an ageing population who live with a range of chronic conditions.’ [1].

Indeed the number of deaths among older people and deaths due to palliative care sensitive conditions [2] is increasing. [3] However, as annual number of deaths stabilises with some palliative care sensitive conditions the trend towards more deaths is observed with others. [3]

Understanding who is dying, what they are dying of, and where they are dying can help us to focus our palliative care resources and training where needed and to prepare for future demand.

 

What the numbers tell us:

In 2017 palliative care sensitive deaths accounted for 47% of all cause deaths in Australia, and increased in number by 9.3% compared to 2013. Over this period the annual number of deaths due to dementia and Chronic Obstructive Pulmonary Disease (COPD) increased substantially, and older people accounted for the majority of all cause deaths.

 

 

Where people die tells us where palliative care services might be needed.

In Australia this is changing although hospital still accounts for more than half of all deaths. [3,4] However, residential aged care (RAC) is increasingly a place of death and this suggests the need for staff with skills in palliative care.

 

 

Graph showing changes in place of death in Australia comparing 2005 with 2015: Deaths in Hospital show slight rise; Deaths in RAC Show an Increase by approx 20%; Other including private home show a decrease by approx 0%

 

This brief overview has highlighted the growing need for palliative care particularly among older people and people with non-cancer life-limiting conditions. While the nursing workforce is growing the challenge is to ensure all nurses receive training in palliative care and that those settings with increasing demands can benefit from leadership to implement best practice models of care. 

Resources

The following resources for nurses can be useful to acquire new skills in palliative care, implement best practice models of care, and to develop policy and processes to improve palliative care delivery:

Page updated 10 March 2020