Margaret O'Connor

Inclusive or exclusive models of palliative care – which will benefit the person in need of care and how will we know?
Wednesday 30 October, 3.30pm

Like some of her forebears, Dame Cicely Saunders saw the limits of care of the dying in acute settings, which gave her the impetus for the establishment of St Christopher’s Hospice in London. Thus there was a basic historical development of palliative care which was based in “difference”; and while palliative care services have developed beyond UK origins, they are now grappling with varying models of care, as they have grown around the world.

There is a world-wide triple threat to 21st century health systems – the ageing demographics of most western societies, the exponential growth in expensive treatments and the increasing demand for accountability. Palliative care services, no less than other aspects of health care, are required to respond to these challenges. This paper discusses the dominant models of care in the light of these threats and the developing accountabilities that are becoming more important. In particular the paper addresses the ways that many countries around the world, (including Australia and New Zealand), evaluate the standard of palliative care delivery through accreditation programmes. There will be some discussion about the criticisms of accreditation processes particularly in their lack of sufficient sensitivity to palliative care service differences. And recently commenced Australian work sees Palliative Care Australia, auspiced by the Australian Government, developing a parallel self assessment, peer review program that links with the requisite accreditation processes.

Advanced practice in palliative care nursing – Implications for future planning
Thursday 30 October, 9.15am

As palliative care has developed as its own specialty, nurses have become visible in all aspects of palliative care, from establishing services and shaping practice through clinical leadership, sole practitioner roles, management, education, research and policy development. The clinical role in palliative care nursing in is unarguably central, in providing the core needs of the dying person and their family and carers. Palliative care nurses operate in a variety of clinical settings, where they may work alone or in teams that are varyingly constructed. Models of care also vary from specialist consultancy services to primary health care providers and acute services.

Drawing on a study undertaken with nurse consultants working in acute hospitals, this paper discusses the professional requirements for specialist palliative care nursing. This study revealed that these senior roles had developed in response to their own hospital situations, in areas like introducing the concept of palliative care to patients, their families and others; connecting to other services; liaison and advocacy, both within the hospital and to other services that may be required at home. The study demonstrated that while advanced practice roles theoretically require a common base for benchmarking and the development of competencies, the roles necessarily are also locally responsive.

Future roles for palliative care nursing depend on the foundations that are laid in our current health care system. So nurse practitioner, primary health care and other roles need to be promoted with good evidence to back their development. With increased community awareness of palliative care services leading to increased demand for service, newer roles for palliative care nursing will involve courageous creativity in a climate with anticipated health care workforce shortages.

Background bio;
Margaret is president of Palliative Care Australia and for the past four years has held the inaugural Vivian Bullwinkel chair in nursing, palliative care, School of Nursing and Midwifery, Monash University, Australia.

The Vivian Bullwinkel chair formally encompasses three clinical partners on the Mornington Peninsula in Melbourne. Margaret is responsible for the school’s palliative care research team and manages a number of clinical research projects.

These projects are centred around three key areas - service systems issues, issues of culture and care of veterans at the end of life.

Margaret also sits on many state and national committees related to palliative care and is well-published in her research areas.

She received an Order of Australia honour in 2005 for services to the development of palliative care in the state of Victoria.