Debbie White Nurse Practitioner Palliative Care Port Macquarie Community Health Campus

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Community Innovation The Development of a
Nurse Practitioner Model of Care in Palliative
Care
Debbie WhiteNurse Practitioner Palliative
CarePort Macquarie Community Health
Campus October 2013
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Purpose

• Explore model of care and the NP role
• To share a narrative of my experience
• Illustrate the highlights and challenges along
  the way
• Demonstrate the benefits for the patients and
  families

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Model of Care

• A way of working
• A multidimensional concept that describes how
  health services are delivered (QLD Govt 2000)
• Encompasses patient centred, safe, effective,
  equitable, quality, efficient, cost effective,
  innovative care (NSW Health 2005, WA Govt 2008)
• Ensuring right care, right time, right place

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Nurse Practitioner

• A registered nurse who is educated and endorsed
• to function autonomously and collaboratively in
  an
• advanced and extended clinical role
• Assessment management skills
• Referral, prescribing medications, ordering
  diagnostic investigations
• The role is grounded in nursing values,
  theories, knowledge
• Provides innovative and flexible health care
  delivery that complements other health care
  providers

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Safety Quality Framework for NPs
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Nurse Practitioners in Palliative Care

• Standards for Palliative Care (PCA) NP listed
  as part of specialist level services
• In NSW there are 5 NPs and 1-2 Transitional NPs
  in place
• A valuable addition to the Palliative Care MDT

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Palliative Care

• For people with a life limiting illness
• Multidisciplinary approach
• Cares for the patient and family
• Impeccable assessment and early treatment of
  symptoms
• Holistic approach physical, spiritual, cultural,
  emotional
• (WHO 2005)

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Palliative Care in NSW

• In rural / regional NSW ? 1.6 fte Palliative Care
  Specialists
• High chronic disease burden
• 10 of patients with chronic disease receive
  palliative care
• 66 of cancer patients receive palliative care
• Flexible, innovative approaches to meet the
  demand and provide a sustainable service

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The Journey..
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The Beginning.

• Role commenced in 2011
• Hastings Macleay Clinical Network
• Community based role
• Home
• Wauchope PCU
• Residential Aged Care
• Kempsey Hospital
• Nurse Led Clinic
• Clinical, Education, Leadership, Research

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Finding my place

• An additional position for an already established
  team
• Skilled Clinicians
• Transitioning from CNC to NP
• Different responsibilities
• New CNC role developing
• In the team, or an extension of the team?

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Challenges..

• Doctors and NPs
• MBS Number
• Lack of understanding of the role
• Covering a large geographical area
• No Palliative Care Specialist
• Developing a new role
• support systems
• Structure
• expectations

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Data

• 54 weeks
• 612 OoS (n of patients 150 160)
• Referrals n 160
• Malignant 65 Non-Malignant 20 Unknown 15
• Consults ?

P/U PCT GP RACF Direct Hosp
40 31 7 9 35 38
25 19 5 6 22 24
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An Evolving Role

• Learning, researching, waiting
• Changing expectations without changing beliefs
  and values
• Working with the team challenging ways of
  working
• Introducing innovation, identifying gaps
• Collecting data
• Expanding own scope of practice

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A Model of Care.
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The biggest lesson or realisation..

• The role is still very new despite recent
  progress at state and national level

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Questions