Demand for care at the end of life is set to shape our health care system. What is required and makes a difference is encapsulated in palliative care. This is more than providing adequate relief for physical symptoms such as pain, and more than terminal care. For the person approaching the end of their life and their families, care of the physical, emotional, spiritual, and social needs with a focus on quality of life and personal values and preferences is important to them and central to palliative care. It is about living as well as possible for as long as possible.

As the largest health professional group, nurses already take on the role of providing this care although they may not recognise it as such. For many, palliative care was not part of their training and their experiences of providing this care infrequent. Yet caring for people with advanced chronic illnesses such as heart, renal, or respiratory failure, or dementia almost certainly involves elements of palliative care. Recognising these as life-limiting illnesses and monitoring and responding to the broader set of needs recognised by palliative care can improve care.

Changing demographics and increasing demand mean the call for nurses to take on this role is set to increase substantially. The more than one million Australian residents over the age of 80 years, half a million Australian residents with dementia, 600,000 with frailty, and 2.2 million with pre-frailty are just some of the groups whose members may benefit from palliative care now or in the future. Australia recorded over 171,000 deaths in 2021. An economic outlook report prepared by KPMG for Palliative Care Australia projects that between 2019 and 2060, ‘total deaths will surge by 135% to 400,000, of which 214,000 will require palliative care services’. Knowing what to prepare for and how to support workforce capability is important.

Nurses are likely to continue providing most of this care. The 2021 Census informed us that 1.7 million people are working in Health Care and Social Assistance in Australia, of which almost 270,000 are registered nurses and one in three are working in hospitals. The only group coming close in numbers to nurses are aged and disability carers who represent one in eight members of this workforce.

So, what will the role of nurses be and how can this be balanced with everything else they have responsibility for? This will of course vary depending on the care context and available resources including workforce. However, most people do not have complex needs at the end of life and can be cared for in their own community by their usual care team, that is, health professionals not specialised in palliative care. Awareness of appropriate care pathways, potential needs, and local support services will help to them to tailor care to individual people and their families. For people with complex needs, either continuously or sporadically, access to specialist palliative care services will be important.

Most nurses naturally extend their skills as needed. Knowing where to find out what that might include and how to recognise individual needs is important. This is where the CareSearch evidence-based resource for palliative care information can help and why the recent major update was necessary. For more than a decade this government-funded resource has ensured that everyone in need of assistance to access or provide palliative care has support. The CareSearch Nurses Hub is a key component of this with information for nurses newly taking on skills in palliative care through to specialists needing to tailor care to specific needs. The updating and expansion of the hub this year means that it now provides even more practical information and connects nurses with key resources that reflect their roles and scope of practice.

So that this resource is responsive to nurses’ needs and clinical context, we worked with a steering committee of six nurses from aged care, community, acute, and rural and remote sectors. A larger group of nurses who responded to a call for an expression of interest also provided valuable insights and advice. You can read more about our project and partnering with nurses in our Palliative Perspectives blog.

To make it both accessible and useful, the hub organisation is based on key activities so that nurses can easily select what they need across:

• Communication: an essential part of palliative care, explore ways to gather and share information respectfully and compassionately
• Assessment: find out how to recognise needs and monitor for changes
• Planning and Coordinating Care: learn how to involve individuals and teams in planning and care coordination for current and future needs
• Clinical Care: find practical information on responding to physical and psychosocial needs
• The Dying Patient: understand how to recognise and manage imminent death and respectfully conduct after-death care
• Loss, Grief, and Bereavement: learn how to support those going through grief and bereavement
• Tools for nurses in palliative care: find a range of forms, checklists, and tools to assist you in providing palliative care

Continuing Professional Development is an integral part of nursing. To help with this, information on how to recognise, assess, and manage commonly experienced symptoms and issues is accompanied by My CPD reflections forms to record learning activity across the ten symptoms.

The current and anticipated rise in number of deaths is in part a consequence of the longer lifespan being enjoyed by Australian residents. Being prepared to meet the needs of people coming to their end of life today and tomorrow is part of the nursing role. While CareSearch also has information for palliative care specialists, you don’t have to become a specialist to take up your role. Knowing where to find information you can trust and implement when and as needed will already make a difference – for you and the people you care for.

References

1. Australian Bureau of Statistics (ABS). National, state and territory population [Internet]. Canberra: ABS; 2022 March [cited 2022 November 10]. Available from: https://www.abs.gov.au/statistics/people/population/national-state-and-territory-population/latest-release
2. Australian Institute of Health and Welfare. Dementia in Australia [Internet]. Canberra: Australian Institute of Health and Welfare, 2022 [cited 2022 Nov. 10]. Available from: https://www.aihw.gov.au/reports/dementia/dementia-in-aus
3. Taylor D, Barrie H, Lange J, Thompson MQ, Theou O, Visvanathan R. Geospatial modelling of the prevalence and changing distribution of frailty in Australia – 2011 to 2027. Experimental Gerontology. 2019;123:57-65. DOI: https://doi.org/10.1016/j.exger.2019.05.010
4. Australian Bureau of Statistics (ABS). Deaths, Australia [Internet]. Canberra: ABS; 2021 [cited 2022 November 10]. Available from: https://www.abs.gov.au/statistics/people/population/deaths-australia/latest-release
5. KPMG & Palliative Care Australia. Investing to save: The economics of increased investment in palliative care in Australia. Canberra; 2020.
6. Australian Bureau of Statistics. A caring nation – 15 per cent of Australia’s workforce in Health Care and Social Assistance industry [Internet]. Canberra: ABS; 2022 October 11 [cited 2022 November 10]. Available from: https://www.abs.gov.au/media-centre/media-releases/caring-nation-15-cent-australias-workforce-health-care-and-social-assistance-industry

Authors

Susan Gravier, Research Officer, CareSearch and palliAGED, Flinders University
Dr Katrina Erny-Albrecht, Senior Research Fellow, CareSearch and palliAGED, Flinders University