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 White Nurse Practitioner Palliative Care Port Macquarie Community Health Campus October 2013. Purpose. Explore model of care and the NP role To share a narrative of my experience - PowerPoint PPT PresentationTRANSCRIPT
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
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
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
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
Safety & Quality Framework for NP’s
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
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)
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
The Journey…..
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
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?
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
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%
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
A Model of Care….
The biggest lesson or realisation..
The role is still very new despite recent progress at state and national level
Questions…