Palliative Care Link Nurse Program in regional residential aged care facilities

  • Abbe Rejack Palliative Care Nurse Educator Pictured with Colleague Paul Tait, Project Pharmacist for Regional Hospice in RACF.
    Abbe Rejack Palliative Care Nurse Educator and lead for the Palliative Care Link Nurse Programme pictured with colleague Paul Tait, Project Pharmacist for Regional Hospice in RACF.
By
Abbe Rejack, Palliative Care Nurse Educator, Rural Support Service.
Government of South Australia
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In 2021, the South Australian and Commonwealth Governments, under the Comprehensive Palliative Care in Aged Care Project, funded the Regional Hospice in Residential Aged Care Facility Project. The aim of this project was to improve the confidence of the aged care workforce in managing residents palliative care needs.

As a Registered Nurse, with 17 years’ experience working in regional and remote communities, predominantly in specialist palliative care services, I was able to appreciate some of the challenges the regional aged care workforce face, for instance, I have been involved in scenarios where aged care staff lack knowledge and confidence around managing palliative care needs at end of life. Furthermore, I have witnessed a lack of experience around practical issues such as management of infusion pumps and the role of injectable medications.

Evidence from the acute sector describes Link Nurses (LN) as local mentors to build confidence, problem solve and improve practice. More broadly, the role of a LN programme is to foster a community of practice among a group of nurses to promote expertise in a specialist area of nursing and encourage education among peers and colleagues. Applying the LN model to aged care offered an innovative way improve these outcomes and connect with the regional aged care workforce to meet the challenges they experience.

The project encouraged participation from each regional Residential Aged Care Facility (RACF) and nearly all our pilot sites nominated a LN. It was estimated LNs would require four hours per month to participate in the program components, including attendance at monthly educational meetings, participation in Needs Rounds to support clinical discussion and advocate for the Palliative Care needs of residents and complete auditing processes to support quality improvement.

In some RACF, particularly smaller sites, LN participation varied due to workplace challenges, such as staffing shortages in response to covid outbreaks, emergency related clinical demands, staff working overtime to accommodate for workforce shortages and transient staff, particularly where employment of agency staff was required.

Whilst we recognised positive participation of over half the LN group, there was a desire to respond to the needs of the group where regular participation was not always achieved. Didactic Recordings of LN meetings were promoted, and a Teams channel was developed to include all participants. This provided a consistent point of contact to share education and resources to allow participants to self-direct their learning and share the content throughout their networks.

A further achievement of this programme has been the ability to tailor education to meet the needs of this regional audience and each RACF. This has been accomplished by encouraging participants to complete the ELDAC personal learning assessment tool. In addition, we have responded to learning needs throughout clinical case discussions and where common themes have been recognised among facilities. An example of this was where more than one facility recognised a need for education around management of cardiac defibrillators at end of life.

Upon reflection, recording and promoting monthly Link Nurse Teams meetings has effectively reached this audience. The virtual platform is helpful for demonstrating some of the practical aspects of care, such as the use of infusion pumps.

There is future opportunity to explore a face-to-face workshop with this group, however, anecdotally it has been recognised that workforce challenges in some regional sites make it difficult to prioritise attendance, therefore, we need to explore the response to a modified face to face platform.

While we are yet to formally measure the overall outcomes of this LN Programme, I see value within this initiative as it promotes accessible learning, professional development and networking opportunities for staff working in regional areas. The goal and outcome of this Link Nurse Programme is to hopefully achieve a state-wide network of Palliative Care champions in regional RACF.  

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