Reflections on establishing a nurse practitioner role across acute hospital and home-based palliative care settings in Australia

Abstract

Background: Nurse practitioners have been well-established in many parts of the world and valued as a senior role in healthcare systems. This paper offers an appraisal of a palliative care nurse practitioner model of care project and augments an understanding of being a nurse practitioner (NP) in the Australian context. Aims: To enhance outcomes for people regardless of care setting; and to enhance professional relationships between hospital and community services. A secondary objective was to facilitate a seamless transition from one service to another. Methods: The setting was a home-based palliative care service and a tertiary acute hospital, between which the role was employed. This paper describes the role from the NP's perspective, using the NP's log of work and personal reflections. Results: Despite describing many challenges, an NP shared model of care has benefits not just for smoothing the client's journey through settings of care, but also for increased opportunities for clinicians to work together. Conclusions: There are opportunities for further research, including models of role implementation, the skills required by the clinician, and acceptance and respect of the NP role.

Using the Tasmanian Palliative and End of Life Care Policy Framework (2022) to assess service delivery in a rural general practice

“…Increasing the accessibility of services and supporting the skill-development of primary care health professionals are essential for equitable palliative care success in rural areas. [17][18][19] Access to health care incorporates a variety of domains, such as service approachability, acceptability, availability, appropriateness, affordability and acceptability. [20][21][22] Primary healthcare providers have an individual and corporate role in addressing each of these domains to increase access to palliative care services in the community.…”

“…Priority 4 of the TPE Framework highlights the capacity of palliative care providers to service their rural communities. Increasing the accessibility of services and supporting the skill‐development of primary care health professionals are essential for equitable palliative care success in rural areas 17–19 …”

“…The important role NPs play in increasing access to home‐based palliative care services in rural areas is evident in our results. Utilising NPs can improve the palliative process for rural patients, 19 reduce the need for hospitalisation for terminal care, 17 and improve interdisciplinary coordination and load‐sharing 18 . This would appear to be particularly important for house‐bound palliative patients prior to the end‐of‐life phase of care.…”

The non-medical surgical assistant and inequity in the Australian healthcare system

“…The Australian literature informs that the APN and NP enhance access to healthcare. [21][22][23][24][25][26][27][28] Nurse Practitioners were first endorsed in Australia in 2001. To date some 1,839 NPs practice in Australia, however, despite being eligible providers with access to the Medical Benefits Schedule (MBS), NPs in the private sector of the Australian healthcare system are only able to access four consultation, six telehealth, and no procedural MBS item numbers.…”

Nursing Performance In-Home Visits

“…In addition to offering more comfort and convenience to patients, home care can be a more economical option compared to prolonged hospitalization or treatment in private clinics. It should also be noted that studies carried out show that patients who receive home care can have a faster recovery and better health outcomes than those who are hospitalized in public hospitals, in addition to preventing infections associated with health care (O'Connor et al, 2018), (Millard et al, 2020), , (Birt et al, 2023).…”