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Improve Access to Treatment

The Australian College of Nurse Practitioners is proud to showcase how Nurse Practitioners are changing the face of healthcare.  Below is a vignette which demonstrates how we improve access to treatment:

Jacqui Culver, Nurse Practitioner - Palliative Aged Care  

My role as a Palliative Aged Care Nurse Practitioner is to see older people in the community or in residential aged care that have advanced chronic disease and are within the last year of life. 

My role includes:

  • Advance Care Planning discussions
  • Advanced clinical assessment and symptom management
  • End of life care and treatment

My work is varied and complements the care provided to my clients by their General Practitioner by providing specialised assessment, timely intervention, health literacy, clinical management and ongoing monitoring through an acute or unstable phase of end-stage chronic disease.  I also augment specialist palliative care services by providing symptom management for older people at end of life.

Case Study: Amelia

Amelia [actual identity changed] was 82 years old and lived alone in a mobile home village.  Amelia was referred to myself for Advance Care Directive discussions and future planning when it was felt she was likely within the last year of life.  Her husband died four months previously, and had been Amelia’s primary carer.  Amelia wanted to stay within her own home for as long as possible although she had chronic illnesses with frequent episodes where her illnesses worsened.

When I met Amelia, we had an extensive discussion where I discovered the following:

  1. She had chronic right hip pain, which made walking and completing tasks around her home quite difficult.  Because of this hip pain she had missed many of her appointments with her GP and was not eating well because she could not stand and prepare her own meals.  Amelia was frequently tired and spent a great deal of time sitting, which was making her weaker day by day.
  2. She was having frequent nosebleeds and was on a medication known to thin her blood.  After careful examination, I discovered that she had been on too high a dose of this medication.  Her hip pain had prevented her from seeing her GP about her nosebleeds.
  3. Amelia was a known insulin-dependent diabetic.  She had been experiencing low blood sugars for several weeks, which I discovered was likely due to a combination of her diet, activity and excessive self-administered insulin.  Her low blood sugars were likely contributing to her fatigue.  Amelia had called the GP surgery to speak with her practice nurse about this issue several weeks ago, but the nurse had been on holiday.

Over the following two weeks I visited Amelia twice a week and called her on alternate days. I liaised with her locum GP as her primary GP had been on leave.  I ordered appropriate blood tests and collaborated with a diabetes nurse specialist to manage her diabetes.  I ordered X-rays, conducted pain assessments and prescribed trials of additional pain medications to assess and ease her hip pain.  I also provided education on pain management, blood sugar monitoring, and assisted with falls prevention in her home.   I adjusted her warfarin and liaised with her GP to ensure ongoing monitoring.

I referred her to a team of aged care specialists who provided her with physiotherapy and nutrition  services which enabled her to stay safely in her home.  Finally, I coordinated and managed the Advanced Care Planning discussion with Amelia and her son and conveyed this plan to her GP.  Once stable, I referred her back to her primary GP for ongoing management but left my contact number for future concerns if she was unable to get into her GP. 

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