Important: This article provides general Australian health information. It does not diagnose a condition, replace an individual assessment or change instructions from your doctor or treating team.
Palliative care can be provided in different settings
Palliative care supports people living with a life-limiting illness and can be provided at home, in hospital, in hospice or in residential care. The right setting can change as symptoms, care needs and available support change.
Community nursing is one part of a wider palliative team. A GP, medical specialist, specialist palliative service, pharmacy, allied health professionals, family and carers may each have defined roles.
Make goals, roles and decisions visible
A handover should identify what matters to the person, their preferred place of care, communication needs, cultural and spiritual preferences and who may make decisions if they cannot speak for themselves. Current advance care documents should be available to the authorised team.
The plan also needs practical clarity: who prescribes, who supplies medicines and equipment, who can give each medicine, who to call after hours and what changes require hospital or emergency care.
A useful community nursing referral
Send enough information for clinical intake to determine whether the requested nursing work can be provided safely. A diagnosis and visit frequency alone are not enough.
- Current clinical status, goals of care and treating-team contacts
- Medication chart, symptom plan and authorised administration routes
- Advance care plan or directive and substitute decision-maker details where applicable
- Expected nursing tasks, observations, personal care and manual handling needs
- Equipment, pharmacy, consumables and home-access arrangements
- Deterioration, after-hours, ambulance and expected-death procedures
Home care needs a realistic escalation plan
Wanting to remain at home is important, but it does not remove the need for specialist advice or hospital care when symptoms cannot be managed safely in the current setting. The plan should be reviewed early when symptoms, family capacity or equipment needs change.
EmpowerLink can assess the nursing component of an established palliative plan across Greater Brisbane. We do not replace the GP or specialist palliative service, promise a home death, or claim direct Support at Home provider approval. Any partner-delivered aged-care arrangement must be documented before it is described or accepted.
Sources
- About palliative care — Australian Government Department of Health, Disability and Ageing
- Where is palliative care provided? — Australian Government Department of Health, Disability and Ageing