Embedding a Palliative Care Link Nurse (PC-Link Nurse) in Residential Aged Care Facilities in South Australia
An article written by Andrea Rivers-Thompson
Working as a palliative care nurse for the past 12 years, I have been privileged to share the journey and support many patients and their families through their illness to end-of-life. During this time, I have worked in both hospice and community settings across metropolitan Adelaide and regional South Australia. Constantly, I learned that not all nurses and care workers have the confidence, skills, or knowledge to care for a dying person.
As a palliative care nurse educator, my current role with the Rural Support Service provides me with an opportunity to share my clinical knowledge with the regional aged care workforce. Throughout the project, while we discovered that many nurses and care workers are very passionate about palliative and end-of-life care (EoLC), they felt they needed more preparation to have conversations with residents and families about the dying process and the skills that are needed to provide EoLC.
Through the project, we are providing palliative and end-of-life care workshops, mentoring, and monthly Needs Rounds in 15 publicly funded regional residential aged care facilities (RACFs) in regional South Australia. Through these activities, we identified local challenges to making the project sustainable, including inadequate staffing levels, skill mix, and equitable access to education and training, all of which contributed to low morale and lack of staff retention. [1]
The literature supports the link nurse model in many areas of expertise managing similar challenges. [2-3] We are keen to adopt the link nurse role for palliative and EoLC in the regional aged care setting. Melissa Bruno has done significant work to embed these roles in the acute care setting, with favourable outcomes. [4] We plan to leverage the strengths of this model.
We received endorsement for the PC-Link Nurse program from the regional local health networks. Our aim was to recruit one or two nurses in each RACF or regional hospital with aged care beds for the PC-Link Nurse role. While some nurses recruited to the PC-Link Nurse role may have been involved in negative experiences while providing palliative and EOLC in the past, the building of external mentoring and training aims to help them gain self-confidence and knowledge to provide clinical support and lead quality improvement activities that will benefit the residents and their families. Furthermore, using a train-the-trainer model, the mentoring will support the PC-Link Nurse to facilitate educational opportunities for the local RACF staff building more robust clinical governance.
Bruno’s model specifically recognised that the PC-Link Nurse could make sustainable changes in best-evidence practice by considering the challenges in delivering good palliative and EoLC within the local multidisciplinary context and how the team approaches care. [3] Indeed, through ongoing engagement with our project, the PC-Link Nurse program has built-in opportunities to support the RACFs in sustaining evidence-based changes to care.
Furthermore, we can evaluate the PC-Link Nurse program through ELDAC After-Death Audits as a data source that records aspects of EoLC and care planning in the RACFs while tracking hospital admissions and length of stay as well as through feedback forms for staff education. The PC-Link Role will support and invest in the senior nursing management and empower individual nurses to be a voice for change.
I am excited to be a part of the future of implementing a PC-Link Nurse program in the regional areas. By providing mentorship and sharing my 12 years of clinical experience with nurses and care workers I aim to build their confidence, skills, and knowledge, to be able to provide the best evidence practice in palliative and EoLC ensuring a positive experience for the residents and the people that love them.
References
- Royal Commission into Aged Care Quality and Safety. Aged Care Royal Commission Final Report: Recommendations (678kb pdf). Royal Commission into Aged Care Quality and Safety: 2021 Feb.
- Lang S, Harris J. An infection control link nurse network in Residential Aged Care: Innovation in collaboration. Aust Nurs Midwifery J. 2020 Jan-Mar;27(6):50.
- Moir C, Taylor P, Seaton P, Snell H. An Evaluation of Barriers and Facilitators for a Pressure Injury Prevention Link Nurse Role. J Wound Ostomy Continence Nurs. 2022 Jul-Aug;49(4):314-321.
- Bruno M. The introduction of a palliative care link nurse programme to improve nurses' attitudes, knowledge and confidence in providing end-of-life care in an acute care setting. Int J Palliat Nurs. 2022 Nov 2;28(11):540-545. doi: 10.12968/ijpn.2022.28.11.540.
Useful links
Embedding PC-Link Nurse in residential aged care facilities
Andrea Rivers-Thompson
Palliative Care Nurse Educator
Rural Support Service
Regional LHNs | SA Health
Government of South Australia