Debbie White Nurse Practitioner Palliative Care Port Macquarie Community Health Campus
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Transcript of Debbie White Nurse Practitioner Palliative Care Port Macquarie Community Health Campus
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Debbie WhiteNurse Practitioner Palliative Care
Port Macquarie Community Health Campus
October 2013
Community Innovation:
The Development of a Nurse Practitioner Model of Care
in Palliative Care
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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 NP’s
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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 NP’s and 1-2 Transitional NP’s 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 NP’s
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…