Collegian (2008) 15, 151—157

avai lab le at www.sc iencedi rec t .com

The palliative care clinical nurse consultant:An essential link

Margaret O’Connor, RN, DN MN, B.Theola,1, Ysanne Chapman,RN, PhD (Adelaide), MSc (Hons), BEd (Nsg), GDE, DNE, DRMb,∗

a Vivian Bullwinkel Chair of Palliative Care, School of Nursing and Midwifery, Monash University,Peninsula Campus, McMahons Road, Frankston, Victoria, Australiab School of Nursing and Midwifery, Monash University, Gippsland Campus,Churchill, Victoria, Australia

Received 8 August 2007; accepted 14 June 2008

KEYWORDSPalliative care;Palliative care nurseconsultant;Scope of practice;Nursing roles;Role clarification

Summary This study describes the role of acute hospital palliative care nurse consultantsand makes recommendations about future directions for the role development of this role.While the palliative care nurse consultant role is accepted in the acute setting there is littleevidence or literature about what contributes to the success of this role. A three-phase studywas undertaken to describe the role of palliative care nurse consultants in acute hospitals inMelbourne, Australia. The first phase of the three-phase study, involving in-depth qualitativeinterviews with the palliative care nurse consultants, is reported in this article. Using open-ended semi-structured questions, 10 palliative care nurse consultants were interviewed usingopen-ended questions about aspects of their role and the interviews were thematically anal-ysed. Four main themes were identified that clarified the role; being the internal link; beingthe lynch pin; being responsive and being challenged. The palliative care nurse consultantswere the first point of introduction to palliative care and thus they saw a significant role inintroducing the concept of palliative care to those requiring palliative care, their families andothers. They are an important link between the settings of care required by people access-ing palliative care—–acute, in-patient palliative care and community care. The palliative carenurse consultants saw themselves in leadership positions that in some ways defy boundaries,

because of the inherent complexity and diversity of the role. The palliative care nurse con-sultants’ role appears to be pivotal in providing expert advice to staff and people requiringpalliative care, and connecting palliative care services both within the hospital and to externalservices.© 2008 Royal College of NursingInternational Books Australia Pt

∗ Corresponding author. Tel.: +61 3 5122 6670.E-mail addresses: Margaret.oconnor@med.monash.edu.au (M. O’Conn

1 Tel.: +61 3 9904 4053.

1322-7696/$ — see front matter © 2008 Royal College of Nursing, Australia. Published by Elsevie

doi:10.1016/j.colegn.2008.06.002

, Australia. Published by Elsevier Australia (a division of Reedy Ltd). All rights reserved.

or), Ysanne.Chapman@med.monash.edu.au (Y. Chapman).

r Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.

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ntroduction

eath frequently occurs in acute hospitals and as a conse-uence there is a large emphasis on palliative care in thisetting (White, 1998). In spite of this there is limited dataescribing the role of expert palliative care nurses work-ng in clinical nurse consultant (CNC) roles. The literatureescribing the CNC role illustrates the diversity in this role,rom the work undertaken, the setting of such roles and thecademic requirements of the position (Woodward, Webb,Prowse, 2005; Borbasi, 1999).Nurse consultant roles in the United Kingdom were estab-

ished during the 1990s, to respond to the changing needsithin the National Health System (Woodward et al., 2005).otterall, Lynch, and Peters (2007) report that in the UK, it

s estimated that 90% of people will require hospital care inhe last year of life; thus the availability of palliative caren this setting is vital. A major component of this role is pro-iding emotional support to both patients and their familiesSkillbeck & Payne, 2003), with the perceived benefits ofhe role being their ability to manage pain and psychologi-al symptoms as well as being an advocate for patients andamilies (Jack, Oldham, & Williams, 2003).

In Australia, the term ‘Clinical Nurse Consultant’ (in sometates called Clinical Nurse Specialists) has traditionallyesignated a nurse of seniority, often holding in-charge sta-us (Fitzgerald, Pearson, Walsh, Long, & Heinrich, 2003).his categorisation implied that the role is an experiencedurse, who provided broad clinical leadership and in addi-ion, assumed tasks in quality improvement, facilitated caref the person, strategic planning for the ward or specialtyrea, and the conduct of research (Fitzgerald et al., 2003).or the purposes of this article a palliative care nurse con-ultant is defined as a senior nurse working in a consultancyole within a palliative care service. In Victoria, the clinicalurse consultant role is classified in the industrial award at aenior level of Grade 4B or 5 (Australian Nurses Federation,006). Blackford and Street (2001) have suggested that pal-iative care nurse consultants played a twofold role: asonsultants within the inpatient environment and facilitat-ng communication with other providers outside the hospitaletting. White (1998) has described six common aspects ofalliative care nurse consultants: being a resource to oth-rs; counselling; having specialist knowledge; involvementn discharge planning; and education and research roles.

Specific palliative care nurse consultant roles in acuteettings were first established in Australia in the mid-1980s,nd from the beginning, the service model that emergedas a consultant service to all units within the hospital,roviding advice for symptom control, discharge planning,utpatient review and terminal care for inpatients, eithern the hospital or at home (personal communication, 2006).he title was usually designated as a ‘‘nurse consultant’’.hile the position was regarded as a senior nursing position

n the hospital, at that time within the nursing industrialwards there was no specific clinical position for palliativeare nurse consultants (personal communication, 2006).

White (1998) purported that the success of the role was

ependent on both the hospital (i.e. how the role was inte-rated) and the incumbent (in terms of their skill). Theorld Health Organisation (1990) suggested that palliative

are services best function when they were working together

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M. O’Connor, Y. Chapman

ith cancer services and not perceived to be in competition;hus the palliative care nurse consultant role was one thatrovided a linkage between all services. Yet in seeking clari-cation of the role, there was little evidence that palliativeare nurse consultants defined the scope and practice ofhat they do; therefore making this research pertinent.

Palliative care nurse consultants have been employed atost Melbourne acute public (and some private) hospitals

or a number of years and have been accepted as part ofn integrated care model, yet there is little evidence or lit-rature about what contributes to the success of this role.necdotal reports have indicated that the role had becomeivotal to staff and people requiring palliative care. Theseeports identify the palliative care nurse consultants’ role inroviding expert advice, connecting required services, liais-ng and advocating on behalf of patients and their families,oth within the hospital and with other community-basedervices. The role appeared to be responsive to local needs,ith little commonality regarding title, classification and

cope of practice across institutions.A three-phase research project was developed and sup-

orted by the palliative care nurse consultants through theirpecial interest group and was actioned by the first authorho was known to a number of members in a professionalapacity (O’Connor, Peters, & Walsh, 2008). The palliativeare nurse consultants expressed an interest in undertak-ng research that would highlight aspects of their role androvide data for the continuation and expansion of theirole. The first phase, involving interviews is reported in thisrticle.

The aims of phase one were to:

describe the role of the hospital palliative care nurseconsultant in order to highlight commonalities and dif-ferences;make recommendations about future developmentaldirections for the role.

esearch methodology

n explorative descriptive qualitative approach was imple-ented to undertake phase one of the study. This approachas selected to facilitate an in-depth exploration of the pal-

iative care nurse consultant role. The palliative care nurseonsultant special interest group served as a reference groupor the project, in providing feedback, and linking betweenhe researchers and each of the participating hospitals. Uni-ersity Ethics approval for the overall three-phase projectas received along with approvals from relevant hospitalthics committees. The first phase involved in-depth quali-ative interviews with palliative care nurse consultants.

The participants were initially recruited from withinhe palliative care nurse consultant special interest group;ther interviewees were also sought through invitationrom a member of this group. The inclusion criterion wasimply that that nurse had to be working in a palliative

as circulated to the group and interested palliative careurse consultants contacted the chief investigator whorranged a suitable time and place for the interview. Formalritten consent was obtained from participants prior to

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commencing the interview, which was audio-recorded andtranscribed and conducted by the chief investigator ineach palliative care nurse consultant’s place of work. Eachinterview took approximately 45 min and all interviews took5 months to complete.

Interviews were analysed using thematic analysis. The-matic analysis was carried out using van Manen’s six stepprocess (1990) and both authors reached agreement on thefinal themes through reading and re-reading the emergentthemes and the structuring of information through continu-ous dialogue.

Findings

Ten nurses working in the palliative care nurse consultantsrole contacted the chief investigator to participate in thestudy, representing about two thirds of the membership ofthe special interest group. These nurses worked within dif-ferent organisational structures; sole practitioner or as partof a purposefully structured multi-disciplinary team. Somewere the only palliative care nurse in the hospital; othersworked either alone or with nurses and other health pro-fessionals in a team. The length of experience of the nursewas the only demographic data collected—–this varied from12 months to 20 years, with the average length of experi-ence being nine years. The data concerning aspects of theconsultants’ role unfolded into four themes namely, beingthe internal link; being the lynch pin; being responsive andbeing challenged.

While the composition of the team influenced the themesthat emerged, themes were not influenced by the hospitalsetting, or the individual’s experience.

Being the internal link

This broad theme described how the palliative care nurseconsultants worked within their respective acute care set-tings and how the role impacted within that setting. Theseroles included: being an advocate and assessor for both peo-ple requiring care and staff; a liaison person between staffdiscipline groups and between staff, patients and their rela-tives; a counsellor for staff, and an educator and consultantfor other nurses. Care of terminally ill people was central toall these aspects:

. . .I am called on to see patients and assess them andmaybe it might be something as simple as . . . symptommanagement or look at how we can best care for themnow they have been given a palliative diagnosis and ofcourse comes discharge planning (Participant 2).

Many participants described their daily activities as‘doing a circle’ — consulting with other staff, monitoringthe ill person, supporting and counselling families — crossingtraditional boundaries in liaison with other agencies:

. . .advising on symptom management. . . . the staff see a

need either for increased symptom management or sup-port for families or even just support for themselves; tosay can you look at them and give us your opinion. . . . soI guess in many ways we are a backstop for the staff(Participant 6).

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The palliative care nurse consultants considered thathey were filling the gaps between the services with whomhey needed to work. Often they were the first to intro-uce palliative care to those requiring care, and theiramilies and were ‘‘breaking new ground’’ in facilitat-ng end of life conversations, in particular, addressing the‘tough stuff’’. While modelling the expertise inherent inhis role, especially pain and symptom management, theurses also felt undervalued by their colleagues and frus-rated by those who did not utilise their expertise, to theetriment of good care. They balanced the need to edu-ate staff with the need to not take over the sick person’sare:

I think sometimes there is—–it is almost a double edgedsword. In some ways I think they (other nurses not spe-cialising in palliative care) are just happy to hand thecare over and not have to do it. And then we may gothrough a few things with them and teach them (Partic-ipant 1).

The participants commented on the broad scope of theirole and how it was supported by all facets of the health carerofessions—–social workers, medical consultants, nurses,edical registrars, physiotherapists and pharmacists. Much

f the work with interdisciplinary team members was edu-ational, with ‘‘. . .a range of expertise within all thoseisciplines’’ (Participant 10). Working with junior staff wasn area where palliative care nurse consultants assistedhem in learning to anticipate the needs a person mightave:

. . .it’s a matter of educating them, but yeah, acknowl-edging that we work in a large teaching hospital and thatyou are working with interns who are just out of theirtraining (Participant 10).

The palliative care nurse consultants described their roles multidimensional and complex, varying from day to daynd unpredictable as each day unfolded and ‘‘as much ashe unpredictability can be exhausting, that’s what makest interesting’’ (Participant 10). A key strategy in promotingheir role was the ability to be flexible and not to becomeverwhelmed by the diversity of functions and relationshipshey had to negotiate.

eing the lynch pin

n important area of work for these participants was theironsultative role. Many participants spoke of their relation-hips in the community and described themselves as beingivotal in giving advice regarding palliative care: ‘‘. . .as aynch pin liaison between community-based palliative carend nursing services in the hospital.’’ (Participant 3). Theyescribed being the main contact point for community agen-ies, requiring a ‘‘flow of information’’ from the communityo the hospital (Participant 3).

Being clear about their role and function was important

o the palliative care nurse consultants because withoutlarity they could not be an asset to the community ser-ices. While terminally ill people died in hospital they maylso purposefully choose to leave hospital to die in theommunity. The seamless care expounded as necessary for

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ontinuity within and without hospital walls was seen asital.

Many participants valued the multiple and varied out-ide functions they assumed as part of their daily work.t times some palliative care nurse consultants found theyerved many ‘masters’ but most suggested they were expe-ienced enough to be mindful of all the responsibilities theyssumed:

I think it requires good communication skills. . . a goodunderstanding of family dynamics. . . I’ve also worked inthe community as well so I guess I’ve got an understand-ing of what it’s like for people trying to care for patientsat home too. (Participant 10).

Discharge planning was described as being poorlychieved, participants surmising that it was not well pre-ared, developed or implemented. They described ‘‘a lotf pressure with discharge to get people out and complexischarge planning is very poorly known’’ (Participant 7).hey saw their role in taking the lead in some circumstancesith one participant suggesting discharge planning ‘‘as veryuch my forte to lead the team in medical, allied health

nd nursing staff’’ (Participant 7).The participants relayed they were ‘on-call’ both within

nd outside the organisation and were frequently asked toee terminally ill people and assess them for their suitabil-ty to receive palliative care services. They made decisionsbout the individual’s need to be admitted either to hospitalr to community palliative care:

We are also available to liaise with patients who havecome into the Accident and Emergency Department.Sometimes we get referrals from the Intensive CareUnits or the Coronary Care units. So basically anywherethroughout the hospital or the outpatient clinics, we getcalled to see patients. As best we can try and get someof the main referring units. We go to their once weeklyteam meetings as well (Participant 10).

The palliative care nurse consultants believed they func-ioned as consultants both in a hospital and outside, workentring on the ill person’s need. They reported their workithin the hospital was as important as their profile within

he community and they worked hard at realising both.

eing responsive

he participants described the need to work closely with theospital community in which they were placed. Individualare was not seen as limited to ill people and their families,s many palliative care nurse consultants also discussed theirare of nursing staff, medical colleagues and allied healthrofessionals who were anxious about delivering palliativeare:

the staff see a need either . . . support for themselves to

say can you look at them and give us your opinion. . . . Alot of it is that the doctors more often will listen to usthan they will to the staff on the ward. . . . So I guess inmany ways we are the backstop for the staff. (Participant6).

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The length of time and nature of the work required toevelop a responsive relationship with sick people and theiramilies was noted as an often invisible part of the role.owever, for many palliative care nurse consultants theewards were reflected in the positive outcomes of theironnections:

. . .it is not always recognised in the community what hap-pens here. How much hard work actually happens withina hospital setting to get people prepared for even theconcept of palliative care . . . talking to families that havehad perhaps twenty/thirty year connections with someof the units (Participant 3).

Clinical expertise required being responsive in relation toanagement or commentary on treatment variations, family

risis management or providing insights into new care tech-iques. In addition palliative care nurse consultants werealled upon to facilitate debriefing sessions for staff. Asesource persons they were used extensively in situationshere end of life care is not the ‘norm’ in particular ward

ituations. One participant described how she ‘walked aightrope’ when contributing to staff knowledge:

I try and educate about how to go about symptom con-trol. . . .I do go to a lot of trouble to get on with everybodyso that I have a good working relationship and not seen assomeone who just barrels in and orders everybody around(Participant 7).

Being with people at one of the hardest times of theirxistence was a common theme, but every participantemarked on the collegiate support their work permitted.his support had many facets: Participant 5 recalled howorking in a large organisation facilitated her to seek con-rmation of her professional decisions by consulting wither peers. . .‘‘you’re not isolated. . .there’s always some-ne to bounce something off’’. Facilitating peer supportor debriefing was readily available for Participant 6 whoorked as part of a team and noted:

I mean there are often times when we don’t have to sayanything. Just the expression, or you know the cases thatyou are dealing with you just sort of say, ‘‘come on, youneed a drink’’. And you know go off the ward and dowhatever just to wind down a bit before you go back andstart again. . .And if it gets too difficult well you knowthat the other person on the team will go and do it foryou (Participant 6).

The nature of the work meant that effective interactionas pivotal. A palliative care nurse consultant may have

een as many as 20 people (with or without their families) aay within the hospital. These may have been new referralsr readmissions and each required in-depth interviewing,ecessitating the palliative care nurse consultants to havexpertise in communication and a range of skills in speak-ng with vulnerable and distressed people. Providing advicend comment on appropriate care to staff also required theonsultant to be well versed in diplomacy, negotiation and

onflict management:

. . .it’s a consultative role, so we are asked for an opin-ion and its an all encompassing role of anywhere fromsymptom management to acute bereavement counselling

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to discharge planning to discussion of goals of care andcoordinating care in the community (Participant 9).

The palliative care nurse consultants also organised fam-ily meetings with members of the team. Such meetingsrequired timely facilitation of large groups of people whoall sought their issues to be aired and clarified. In this situ-ation the palliative care nurse consultants had to carefullybalance the needs of each person vis-à-vis the needs of theill person:

. . .a high proportion of families would have a sit downmeeting that would involve usually the Registrar, O.T.Physio, Social worker, ourselves, the primary care nurse,patient and family. So you might sit down with ten peoplein the room to actually do that (Participant 5).

Most participants agreed that working with terminally illpeople and families at the end of life was both a privilegeand satisfying. Being able to assist people to come to termswith their own death or the death of a loved one was a majorpart of the role:

It brings out the best in people and the worst perhaps,but generally, you know, the best. It can be very inspir-ing. It can make me feel good if I can go in and help afamily at such an intense time, be more okay about thecrisis (Participant 3).

In some cases participants had a long-standing associa-tion with families, especially with those who had chroniclong term disease processes such as cardiac disease, cysticfibrosis and some leukaemias. In these cases the consultantbecame involved in both acute and chronic phases of theillness as well as discharge and community care.

The participants spoke freely of the personal trust thatterminally ill people and family members developed withthem during the course of their communication. Informationwas confided to the palliative care nurse consultants fromthose for whom they cared, about their fears, their families,their perceptions about life and death. Family members alsodisclosed their innermost apprehensions about treatments,prognoses and emotional impact of their loved one’s illnessor journey towards death. Often sworn to secrecy, the pal-liative care nurse consultants became intimately acquaintedwith furtive information. In the midst of much pain and suf-fering, the nurses were the ‘‘keepers of the stories’’ of thejourney of terminally ill people and their families:

. . .(dealing with) what is the patient’s understanding;what is the family’s understanding; trying to work outwhere they want to be; whether they are comfortable atthe moment; who can we speak to about (them); what’stheir anticipation of what future care would be (Partic-ipant 5).

Participants noted that the role could be described asfluid and inspiring. They suggested that it was a uniquerole in that the palliative care nurse consultant appearsto transgress traditional boundaries that nurses, especiallythose employed in hospitals, work within. Participant 6

remarked:

Well I can’t say our role is rigid. Every day is differ-ent. The way we handle every case is basically differentso . . . you go along and as things come up you’ve got to

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deal with them as you see fit at the time. whatever youhad planned can be so totally blown out the window byother things. . . often because you just don’t know whatyou are going to find.

eing challenged

hile the work associated with the role could be excit-ng and different there were some challenges that stifledts development and rendered it difficult to professionallylassify or fit neatly into the scope and practice of nurses.here were many differences between the participants,heir titles, how they worked and their remuneration. Mostescribed the role as ‘‘unfolding’’ and ‘evolving’’, with aeed to create the role as they live it out through their activ-ties ‘‘. . . well it’s a complex role and it has changed overhose six years now . . . I come into chaos and I give somerder to the chaos’’ (Participant 2).

Some participants spoke of knowing intuitively the needsf the individual yet they were hampered by protocolshat did not permit them access. This obstruction meanthey had to wait until a crisis occurred before they woulde contacted to give advice or refer to other health carerofessionals. The palliative care nurse consultants roleranscended boundaries and in fulfilling a gamut of needs,heir functions were not well understood or promoted. Theyere acutely aware of not stepping on the toes of others orffering advice that could seemingly be misinterpreted asnterference.

. . .they’ve asked me to be involved and I would startoff . . . very gently about what their understanding ofwhat was going on and get them to tell me rather thanme tell them how things are going for them. If I’m get-ting the wrong information, the information is incorrectwe will restart and tease things out (Participant 5).

In attempts to define their role, the palliative care nurseonsultants expressed a need for the common things theyo well to be recognised, namely coordination of holisticare for the ill person and their families at any stage of theisease process, the provision of education; being a resourceerson for all staff involved in providing palliative care; andsupport person for staff, the ill person and relatives as

hey work through some debilitating emotions.For many, the implementation of their role required con-

olidated time. Time was an issue for others, as they feltmpoverished of sufficient time to do what was required ofhem. The needs of people could be overpowering and thealliative care nurse consultants could feel overwhelmedith the burden of tasks at hand.

Administration activities formed a substantial part of thealliative care nurse consultant’s role. Participants men-ioned their management activity in direct contrast to theirlinical role and while recognising the value of keepingecords, they often worked alone, responsible for managingheir own paperwork and filing. These administrative duties

mposed on clinical and education time and placed extraurden on an already restricted working time. Some partici-ants spoke about truncated lunch times, working overtimeo collate records and filing and coming in early or finishingate in order to keep pace. It was clear that administrative

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ssistance for these palliative care nurse consultants wasuite insufficient.

I think that if you’re constantly working overtime all thetime that gets very draining as well. And I think you endup resenting the extra time that you do (Participant 10).

Many participants remarked on how their work locationsere changing. For those in large teaching hospitals they

eported on being called to give advice about palliative caren acute care areas and not just for people dying of cancer:

About thirty percent are not cancer consults. So thathas led us out to the field of renal failure, cardiac fail-ure, respiratory failure, stroke, which is a learning curve(Participant 4).

Those people normally classified as requiring aged care,lso came under the remit of the palliative care nurse con-ultants. As the condition of an older person changed theyould be admitted to the acute care area of the hospitalrom residential aged care and the palliative care nurse con-ultant was asked to provide a service for them and theiramilies. In the main this service was to support the notionf an early discharge either to home or a residential agedare home.

Some palliative care nurse consultants described beingurdened by their involvement with ill people and their fam-lies, which could be emotionally traumatic: Participant 8urported:

. . .getting too overwhelmed with the busy-ness and theemotional side of it. Sometimes it gets hard, really hardif you are close to patients or if it’s too traumatic withsituations happening all at once. Then it’s hard to keepthe energy going (Participant 8).

iscussion

ike the descriptions of the palliative care nurse consultantsound in the literature, the role was that of a senior healthrofessional, with commensurate responsibilities and skillsWhite, 1998). The palliative care nurse consultants them-elves valued and clearly articulated both professional andlinical expertise in their work, with their healthcare col-eagues as well as with ill people and families. However, theignificant range of involvements in the various aspects ofheir role required a mature balancing.

Each participant described their role as blurred andhus often misunderstood, by their health professional col-eagues, in relation to their activities and responsibilities.here were role inconsistencies in all aspects of the posi-ion, from their classification to the tasks undertaken andhe titles used. While these are significant difficulties, par-icularly in endeavouring to find consistency, the palliativeare nurse consultants also highlighted the benefits of beingexible, locally responsive and able to operate both insidend outside the hospital base. Since one of the aims of the

roject was to describe the role, highlighting these com-onalities and differences will assist in developing a more

ohesive and visible palliative care nurse consultant rolecross many settings. A consistent approach to the role willring the roles under the one Award classification and in

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M. O’Connor, Y. Chapman

ome individual hospitals, achieving parity will require addi-ional funding.

The study identified the people-centred nature of theole. A surprising finding was that many of the palliative careurse consultants indicated that they are often the first per-on to discuss palliative care with the sick person and theiramily members. This was a substantial aspect of their workoth in the number of times they found themselves introduc-ng the concept of palliative care and the amount of timehese encounters took. This aspect of the palliative careurse consultant role was in contradiction to the commonlyeld belief that the general practitioner initiated discussionsbout palliative care.

The emotional labour of nurses has been well docu-ented in the literature and evidenced in this study (Smith,

992; Lawler, 1992). From the first meeting with the illerson and their family, it was the responsibility of the pal-iative care nurse consultant to ensure their needs werestablished, particularly in relation to discharge planningnd home supports. These involved giving information abouthat was available and in ensuring referrals were made

o appropriate services. The decreasing length of stay wasoted by a number of participants and the subsequent stressreated by the need to achieve a complex range of tasks inshort time. They firmly suggested that ‘‘good work takes

ime’’.Consistent with the literature (White, 1998), significant

nvolvement in educational initiatives were highlighted byarticipants. This responsibility could be formal educationrograms or informally at the bedside, in consultation withndividual clinicians about particular people. There was anvert need to work in a way that developed the expertise ofthers, rather than keeping the knowledge for themselvesnd this inclusivity was particularly pertinent when one con-idered the rapidly changing workforce.

In recent years palliative care has become an acceptableart of treatment for chronic illnesses such as respiratoryomplaints and chronic heart failure (Loftus, 2000). This roleas assisted in the development of a palliative care profileithin acute hospital settings, introducing palliative care

nto areas like intensive care, to people with chronic ill-esses like cystic fibrosis and in aged care. These trends areignificant in that it has challenged the traditional connec-ions of palliative care to cancer care and demonstrated thealue of palliative care across the acute care setting.

ecommendations and conclusion

his phase of the study has described the palliative careurse consultant role as a leadership position in the acuteetting that is inherently diverse and serves as an essentialink between all settings of palliative care. The four themeshat emerged from the data highlight the major aspects ofhe palliative care nurse consultant role and exposed theomplexity of their day-to-day working life. This data wille utilised to inform the next phase of the study, to collectata about the various task-based aspects of the role.

These data will contribute to defining the role and scopef practice of the palliative care nurse consultant, develop-ng educational requirements for the role and implementingormal programmes of support and supervision. The role ofhe palliative care nurse consultant has been described by

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participants and a profile of common features of this rolehas emerged. This ongoing project will contribute to devel-oping a common position description and then to argue forcommon classification and titles.

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