Nurse Practitioner Palliative Care

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Nurse Practitioner - Palliative Care

• Karen Glaetzer
• Nurse Practitioner Palliative Care
• Southern Adelaide Palliative Services
• Lecturer (B) Flinders University

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Southern Adelaide Palliative Services

• Regional Service Population 330,000
• Interdisciplinary team
• Clinical services, education and research
• 1200 referrals each year
• 380 current clients
• Seamless care model

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Gaps identified in Service Provision

• 30-40 families each year identified by SAPS whose
  needs were not adequately addressed
• 82 referrals in 2002 under the age of 50
• Resource intensive
• Utilised Multiple Service Providers
• Complex psychosocial/psychological issues
• Primary service providers with limited specialist
  palliative care skills
• Limited availability of institution based
  resources

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Triage Criteria

• Chronic complex mental health history
• Long term mental health history who
• require ongoing assessment and treatment.
• Multiple service providers
• More than 3 community service providers (GP,
• RDNS, Dom Care etc).
• Complex symptom issues
• Patients who have significant, complex symptoms
  (physical or
• psychological), that require advanced skills to
  assess and
• manage.
• Family dysfunction
• Families who have demonstrated difficulty coming
  to terms with the
• diagnosis/prognosis and where there is
  significant ongoing conflict
• Complex individual caregiver issues
• Carers who have significant ongoing personal
  (physical or psychological)

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Nurse Practitioner - Palliative Care

• Direct clinical service provision to palliative
  clients with overwhelmingly complex needs
• Coordination of case management, clinical problem
  solving, clinical decision making and advance
  care planning
• New patient OPD Clinics
• MND Clinic

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Nurse Practitioner - Palliative Care

• Provision of education to patients, families and
  professional care providers
• Initiate and participate in research/projects
• Rural Mentor role
• Contributes to State and National Policy
• (State Plan)

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OPD Clinics

• Hospital Funded OPD not medicarised
• 3 patients 1 hour appointments
• Palliative Medicine Consultant holds concurrent
  review clinics
• 15 - 20 minute overlap to assist in co-signing
  investigations or to provide scripts
• Next appointment booked with Palliative Medicine
  Consultant

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NP Role Evaluation
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Journal

• Maintained professional journal over the first 6
  months of role
• Recorded
• Referral numbers from SAPS and reason for
  referral
• Referral numbers from other health services and
  reason for referral
• Planned and unplanned contacts
• Input into care planning
• Main activity referral to others, consultation,
  prescription and ordering rates
• Non-clinical activities
• Research/projects
• Education
• Networking and higher level activities

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Results Snapshot data

• Pre
• Diary
• Mean contacts per day 3.14
• Number of NP criteria met 2.25
• Mean satisfaction scores 8.56/10
• Post
• Diary
• Mean contacts per day 1.92
• Number of NP criteria met 2.6
• Mean satisfaction scores 9.16/10

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Results Staff questionnaire

• Community team n8/11
• Identifying impacts of NP
• Possible reduced need for medical input
• Streamline reviews and assessment
• Reduce stress by reducing complexity of caseloads
• Responsibilities
• Varied opinion (lessened for some, others thought
  no change)
• Consultant seen as supporting NP
• Support
• Most NP as a support and resource, but varied
  opinion
• Attitude to NP role
• Can be viewed as privileged, choice of patients,
  protected time
• Service issues
• Who decides NP patients, how does triage work
• How does follow-up get handled

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Results Journal
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Results

• Number referred to NP 27
• Reason for referral
• Complex symptoms 8
• Family dysfunction 5
• Multiple health providers 4
• Complex mental health history 2
• Caregiver issues 8

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Conclusions

• Patient profile
• By definition, more complex, more severe problems
• Younger
• Die at home
• Difficult to evaluate
• Small numbers
• Limited timeframe
• Methodological issues

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Conclusions

• Triage detects 1/3 patient numbers, other
  referrals after clinical assessment and as
  problems arise
• Journal
• Operates at local, regional, state and national
  level
• Education
• Policy
• Research/project
• Support and consultative
• Extended practice reflected (within legislative
  limitations)
• Case load reflects patients identified through
  triage criteria

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Discussion

• Outstanding features of the role
• High numbers of rural contacts
• Those services where SAPS is already aligned
• Using the knowledge and skill base of NP
• Maintains statewide MND clinic and support
  service
• Local, regional, state and national involvement
  in
• Education
• Policy
• Consultative and support roles

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Possible Palliative Care NP Roles

• Nurse led inpatient beds
• Aged care/ Palliative care
• Chronic disease/Palliative care
• Consultative Clinics hospital, community, RACF
• Community

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Contact Details

• Karen Glaetzer
• RN BN NP Cert Onc Cert Bioethics Grad Cert Health
• (Palliative Care) MNg (Nurse Practitioner) MRCNA
• Nurse Practitioner - Palliative Care
• Southern Adelaide Pallliative Services
• Repatriation General Hospital
• 700 Goodwood Rd
• Daw Park South Australia 5041
• ph. 61 8 8275 1732
• fax. [phone]
• Email. Karen.glaetzer_at_health.sa.gov.au