Background In order for palliative care to be provided to all in need, an integrated approach to service delivery is needed, where a mixture of specialist and generalist care is provided. A needs assessment in 2010 showed 40% of patients in Mulago hospital have palliative care needs. Thus the Makerere Palliative Care Unit (MPCU) developed a programme to train link–nurses across the hospital supported by a referral pathway and identification process.
Aims To integrate palliative care into all wards of Mulago Hospital through a link-nurse programme.
Methods 27 link nurses from 11 clinical areas, were trained and mentored over the past 2 years. An evaluation of the programme was carried out using quantitative and qualitative data collection methods including; pre and post course confidence ratings; course evaluation forms; review of link-nurse activity sheets and action plans; review of MPCU patient documentation; Most Significant Change (MSC); and focus group discussions (FGDs).
Results Link nurses cared for 1,684 patients during 2012, of these, 336 (20%) were referred to MPCU for specialist input. Referral patterns suggest the complexity of patients referred to MPCU has increased with >75% of MPCU patients having complex needs requiring specialist input. Results of the evaluation suggest the link-nurse programme has helped integrate PC throughout the hospital. There has been a change in attitudes, the nurses have developed new skills and knowledge, there is improved relationships and better outcomes of care. Challenges identified include heavy work-load and the need for training for other staff.
Conclusion The link-nurses felt they were able to provide better PC to those that needed it, and had a stronger relationship with the MPCU both in terms of support, but also for referrals. The integration of PC throughout hospitals is vital, and the link-nurse programme demonstrates a successful model.
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