Nurse Practitioner - Palliative Care Karen Glaetzer Nurse Practitioner – Palliative Care Southern...
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![Page 1: Nurse Practitioner - Palliative Care Karen Glaetzer Nurse Practitioner – Palliative Care Southern Adelaide Palliative Services Lecturer (B) – Flinders.](https://reader035.fdocuments.in/reader035/viewer/2022072005/56649ceb5503460f949b6a76/html5/thumbnails/1.jpg)
Nurse Practitioner - Palliative Care
Karen GlaetzerNurse Practitioner – Palliative CareSouthern Adelaide Palliative ServicesLecturer (B) – Flinders University
![Page 2: Nurse Practitioner - Palliative Care Karen Glaetzer Nurse Practitioner – Palliative Care Southern Adelaide Palliative Services Lecturer (B) – Flinders.](https://reader035.fdocuments.in/reader035/viewer/2022072005/56649ceb5503460f949b6a76/html5/thumbnails/2.jpg)
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
![Page 3: Nurse Practitioner - Palliative Care Karen Glaetzer Nurse Practitioner – Palliative Care Southern Adelaide Palliative Services Lecturer (B) – Flinders.](https://reader035.fdocuments.in/reader035/viewer/2022072005/56649ceb5503460f949b6a76/html5/thumbnails/3.jpg)
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
![Page 4: Nurse Practitioner - Palliative Care Karen Glaetzer Nurse Practitioner – Palliative Care Southern Adelaide Palliative Services Lecturer (B) – Flinders.](https://reader035.fdocuments.in/reader035/viewer/2022072005/56649ceb5503460f949b6a76/html5/thumbnails/4.jpg)
Triage Criteria> Chronic complex mental health history Long term mental health history whorequire 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 andmanage.
> 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)and who demonstrate difficulties adapting to the role of carer.
NP referrals meet 2 of these criteria
![Page 5: Nurse Practitioner - Palliative Care Karen Glaetzer Nurse Practitioner – Palliative Care Southern Adelaide Palliative Services Lecturer (B) – Flinders.](https://reader035.fdocuments.in/reader035/viewer/2022072005/56649ceb5503460f949b6a76/html5/thumbnails/5.jpg)
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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M T W Th F
Admin OPD
NHS
Teaching Research Research Meeting
Project Work
Team Meeting
Education
Service Development
Home
Visits
(far south)
Home Visits
4pm Nurses Meeting
OPD
(alt MND, new patients)
Admin
![Page 8: Nurse Practitioner - Palliative Care Karen Glaetzer Nurse Practitioner – Palliative Care Southern Adelaide Palliative Services Lecturer (B) – Flinders.](https://reader035.fdocuments.in/reader035/viewer/2022072005/56649ceb5503460f949b6a76/html5/thumbnails/8.jpg)
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 n=8/11• 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
Number of patients triaged 28%
Education activities 17%
Discussions with external nursing/allied 12%
Discussions with SAPS medical 9%
Referrals to others 8%
Discussions with external medical 6%
Research/project 6%
Discussions with SAPS nursing/allied 5%
Drug/treatment advice 5%
Admissions arranged 2%
Referred to NP intervention 2%
Clinical load, MND clinics NA
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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
Site of death (%)
Mean age
% male
Cancer/non cancer %
Mean LOS (days)
Home Pall care
Hospital Not specified RACF Alive Mean MO contacts
SAPS 71.9 56 82:18 60 9 18 25 9 6 33 1.82
NP 49.2 55 91:9 69 52 33 14 0 0 1 1.72
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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 GlaetzerRN BN NP Cert Onc Cert Bioethics Grad Cert Health(Palliative Care) MNg (Nurse Practitioner) MRCNANurse Practitioner - Palliative CareSouthern Adelaide Pallliative ServicesRepatriation General Hospital700 Goodwood RdDaw Park South Australia 5041ph. 61 8 8275 1732fax. 61 8 8277 4957Email. [email protected]