University of Tasmania, Australia
Christine Stirling has a career long interest in improving community based healthcare through research. Christine is Deputy Dean Graduate Research at the University of Tasmania and Vice-President of the AAG National Board. Her research includes improving services for people with dementia and she was lead investigator on the IM/NPACT project. She had published widely in international peer reviewed journals and has received over 1.5 million dollars in research grants.
This paper describes the realistic evaluation results for a pilot project that trialed Aged Care Nurse Practitioner (ACNP) roles. The case study was undertaken over three years in the Australian state of Tasmania and was one of 33 national pilot projects. ACNPs use extended skills, knowledge and experience in the assessment, planning, implementation, diagnosis and evaluation of care needs but have been little used in Australia. The study evaluated three key ACNP roles: a nurse led memory clinic, ACNPs consulting in doctor’s surgeries, and the ACNP consulting into community settings. The study questions focused on the nature of the ACNP therapeutic encounters, the care collaborations with providers and managers, and the logistical arrangements of setting up the new services. Demographic and clinical data from clients, videorecording of consultations, clinic documentation, and interviews were used to evaluate the ACNP roles. The results highlight the capacity of the ACNP in running a memory clinic and client profiles demonstrated some unusual patterns which may have been related to the open referral policy and being nurse-led. The ACNP in the doctor’s surgery saw a diverse group of clients ranging from 29 to 99 years of age; 63% presented with multimorbid conditions, 22% were diagnosed with dementia or mild cognitive impairment. Developing suitable collaborative arrangements was often time consuming, particularly concerning funding arrangements. Overall, the project demonstrated the benefits of expert ACNP roles in primary health care settings, but also difficulty in establishing new roles within the constraints presented by the current Australian system.