Melissa Barrett

Rural and Remote Primary Health Care Research Fellow

Melissa Barrett

Silver Chain Clinical Nurse Specialist - Geraldton

October 2005 to July 2006

Title:

Implementation and evaluation of a palliative care rural respite nursing service.

Project Summary

Melissa had noticed in her work as a clinical nurse specialist that family caregivers of palliative patients were stressed, sick and exhausted. They told Melissa they had little time away from providing care to their family member and time for themselves. This motivated Melissa to develop the concept of providing respite care for palliative patients in their own home by enrolled nurses (EN). This concept was unique in palliative care since care aides or volunteers previously provided respite. She selected ENs for this service because family caregivers identified fears of leaving their family member with unqualified providers. The reason the family caregiver was exhausted was that they were reluctant to take up respite care by untrained caregivers. Melissa and her team in collaboration with WACHS Palliative Care Service implemented and evaluated a home palliative care respite service. WACHS funded the provision of the EN for the project for six months at seven hours per week

The implementation phase involved four steps. These were the development of a palliative patient assessment battery, training of registered nurses in the use of the assessment tools, the identification of patients for the EN respite nursing service and consultation with the family caregiver.

The evaluation of the new service used a mixed method approach and had important outcomes for the patient, the caregiver and the health system. The evaluation design included analysis of the uptake of the EN respite service, analysis of patient outcomes, caregiver evaluation of the EN-provided respite care and a relative cost analysis. In terms of outcomes, the provision of EN respite care resulted in reduced hospitalizations for palliative patients and a greater proportion of patients being able to die in their home. Both these outcomes have meant significant reductions in health care costs. Also, family caregivers said they were satisfied with specific care tasks delivered by the ENs such as pain relief and symptom management over which they had some concern proper to implementation of the program. However, they were less satisfied with the transfer of information and communication by the care team. We believe that this could be improved by regular case conferencing between the caregivers, patients and the care team.

The program demonstrated that an intervention consisting of a limited number of hours of respite care provided by ENs to palliative patients and their caregivers can be implemented effectively and with improved patient and care giver outcomes. This intervention provided improvements in quality of life for caregivers and patients and significantly reduced costs to the health system. The full report can be downloaded here.

What are you doing now and what has your fellowship led to in terms of your practice and research?”

Melissa is now managing a wound care project based at CUCRH after working as a Clinical Nurse Manager for 6 months in Dongara. She says the fellowship gave her some experience of research and has opened her eyes to a different form of practice. It is difficult to change ones thinking from making a difference to a patients’ life in one day or assisting change on a larger scale. Both are rewarding in very different ways and it keeps up interest and engagement to try new things.