The care of older people at the end of life is a key element of primary community and residential aged care. The Decision Assist – Palliative Care Linkages project aims to improve end-of-life care for older Australians through establishing linkages between aged care and specialist palliative care services. One strategy to achieve this is the linkage nurse role, whose responsibility it is to coordinate the interactions between these services. Various approaches to the role have been identified1-6, and when successfully implemented, it can improve access to specialist services for clinicians, promote greater cooperation between these services, and enable improved continuity of care to clients.
The Linkages project saw 10 sites pilot this approach. The linkage nurse role was not to simply ‘do the work’ of aged care nurses. Instead, it builds the capacity of the aged care workforce to provide end-of-life care for older persons in their usual place of residence. . Designed to provide a coordinated and proactive approach to care, these linkage nurses’ responsibilities varied. Their expertise included overseeing advance care planning; recognising dying; planning care; initiating and conducting family meetings; symptom control; enabling more appropriate referrals to specialist palliative care; providing one-on-one or small group training on site; offering staff debriefing; and engaging external stakeholders. One participant described that the linkage nurse “helped us make sure we are asking the right questions.” A suite of tools to guide clinical decision making was developed and implemented by linkage nurses in many sites.
Differing levels of success and sustainability were achieved. Success factors for the linkage nurse role included strong management support, clear expectations of the role, receptiveness to the role in the workplace, and the skill set of the linkage nurse. Some members of the care team resisted the role, however with improved outcomes for clients, the potential for improved care was seen. For example, linkage nurses markedly increased the number of clinical assessments performed to provide valuable information for discussion with the clients’ GPs; for the most part, this was through mentoring staff to undertake these assessments themselves. In one site, we saw the number of nursing home residents dying in hospital nearly halved over the life of the project, from 40% to 22%. Sustainable change to practice was evident across the 10 sites; as one site stated, “This is now part of our core business.” Can you think of any other areas in healthcare in need of a linkage role?
- Blackford, J., & Street, A. (2001). The role of the palliative care nurse consultant in promoting continuity of end-of-life care. International Journal of Palliative Nursing, 7(6), 273-278.
- Byron, S., Moriarty, D., & O’Hara, A. (2007). Macmillan nurse facilitators: establishing a palliative resource nurse network in primary care. International Journal of Palliative Nursing, 13(9), 438-444.
- Epiphaniou, E., Shipman, C., Harding, R., Mason, B., Murray, S. A., Higginson, I. J., & Daveson, B. A. (2014). Coordination of end-of-life care for patients with lung cancer and those with advanced COPD: are there transferable lessons? A longitudinal qualitative study. Primary Care Respiratory Journal, 23, 46-51.
- Hasson, F., Kernohan, W. G., Waldron, M., Whittaker, E., & McLaughlin, D. (2008). The palliative care link nurse role in nursing homes: Barriers and facilitators. Journal of Advanced Nursing, 64(3), 233-242.
- Meier, D. E., Thar, W., Jordan, A., Goldhirsch, S. L., Siu, A., & Morrison, R. S. (2004). Integrating Case Management and Palliative Care. Journal of Palliative Medicine, 7(1), 119-134.
- Morin, D., Saint-Laurent, L., Bresse, M. P., Dallaire, C., & Fillion, L. (2007). The benefits of a palliative care network: a case study in Quebec, Canada. International Journal of Palliative Nursing, 13(4), 190-196.