1. Nurse Practitioner - Palliative Care
Karen Glaetzer
Nurse Practitioner – Palliative Care
Southern Adelaide Palliative Services
Lecturer (B) – Flinders University

2. 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

3. 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

4. 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)
and who demonstrate difficulties adapting to the role of carer.
NP referrals meet 2 of these criteria

5. 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

6. 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)

7. 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
(alt MND, new patients)

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

9. NP Role Evaluation

10. 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

11. 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
Mean contacts per day = 1.92
Number of NP criteria met = 2.6
Mean satisfaction scores = 9.16/10

12. 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

13. 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
Discussions with SAPS nursing/allied 5%
Drug/treatment advice
Admissions arranged 2%
Referred to NP intervention
Clinical load, MND clinics NA

14. 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 6 33
1.82 NP
49.2 55
91:9 69 52 14 1
1.72

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

16. 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

17. 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

18. Possible Palliative Care NP Roles
Nurse led inpatient beds
Aged care/ Palliative care
Chronic disease/Palliative care
Consultative Clinics – hospital, community, RACF
Community

19. 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
fax .