CareSearch Blog: Palliative Perspectives

As a course coordinator of the palliative care courses at Flinders University I have seen our post graduate student population change over time. Ten years ago, students were primarily health professionals who worked in specialist palliative care services. These students worked to expand and update their knowledge, sharpen their skills and improve their own professional capacity to deliver palliative care. 

Today Flinders’ students still work to grow, change and develop, but the student profile is changing. We work with students who are employed across a range of health services including, aged care, emergency departments, pain clinics, medical wards, adult and neonatal intensive care units, and respiratory wards. These professionals are proactively seeking to expand their skills to meet the needs of the growing number of Australians (up to 52%) with a life-limiting illness and who die in acute hospitals. 
 

New healthcare research is being produced at an exponential rate and the challenges for clinicians to keep abreast of it are well documented. Perhaps less frequently discussed is the question of what happens once relevant evidence has been identified. How does it move from the page to have a tangible influence on patient care or health system outcomes?  

Despite the abundance of research evidence available, we know that it is often slow to reach those that need it, and even slower to be implemented. An oft cited time lag is a staggering 17 years! The implication is that patients may be receiving ineffectual treatments, out of step with best practice recommendation, in the meantime. This must inevitably impact on patient safety, quality improvement processes, and healthcare costs across the sector. 
 

Reflecting on what I do and what my responsibilities are as a Research Nurse is quite complex and one single role cannot encompass all the activities associated with clinical research trials.

Protocol development is the first phase of the project, where a team is involved in developing the protocol. From my perspective, knowledge and experience of a research nurse is indispensable in creating a good balance between the needs of the research and the patients involved.

There is no doubt that nurses are fundamental to health care. There are over 350,000 nurses currently practising in Australia. They are the largest single health profession in Australia. But more importantly, they are most often the face of care to the person needing care. And this is particularly important to remember when thinking about the care needs of an older person who may be the last stage of their life.

Many older people spend some or all of the last year of their life at home. Some will move to residential aged care or will already be in an aged care facility. Others will live with families or friends. Some may spend time in a hospital. Nearly all will be involved with a GP and with their Practice Nurses. So not only are nurses critical in enabling good care for older Australians coming to the end of their life, they will be providing this care in many different settings.
 

We all know that the population is ageing; and the figures forecasted are significant with around 15% (3.6 million people) older than 65 years in 2016 (Australian Bureau of Statistics (ABS), 2013). These figures will continue to soar, and by 2031 it is estimated 19% (5.7 million) of the population will be older than 65 years (ABS, 2013).

In 2015 it was reported that 75% of people aged 65 and over who died in Australia used an aged care service in the 12 months before their death, and 60% were an aged care client at the time of their death (AIHW, 2015).  These figures alone point out the obvious key role the aged care sector plays in ensuring a person’s quality of life reaches its maximum potential as they approach the end of their lives, and inherent within that is the role aged care plays in ensuring a good death.