They are known for being compassionate carers and can often be a patient's most powerful advocate.
For Beth Salleras, a Queensland nurse who has been working in general practice for 18 years, holistic care can be life-changing.
Nurses are both willing and capable to be involved in these conversations -- they just don't know how.
"You develop quite a close relationship when you're seeing patients regularly and when they are becoming quite dependent on general practice -- especially in rural or remote areas," Salleras told The Huffington Post Australia.
"For some, particularly for those with debilitating health, it becomes the focus of their life."
Part of this practice involves talking about death and dying.
"It can be difficult as a health professional to probe this conversation, but it is so important. Some people may be in denial as they come to terms with what may be down the road for them," Salleras said.
"You need to gage whether the patient is prepared to talk about it, and to know how to go about it."
Salleras is one of 4,000 nurses in general practices across Australia who will be offered new training to help discuss the advanced care planning needs of both elderly patients and those with chronic or debilitating conditions.
Advance is a federally-funded program designed to introduce sensitive conversations around bereavement into routine assessment -- and, by extension, identify those who may benefit from early referral to palliative care.
Associate Professor Josephine Clayton is a specialist physician in palliative medicine, with health and aged care provider, HammondCare. Working with a team of international health professionals, she developed the training materials to fill a void in the current state advanced care planning.
"If there is a plan in place for how that person will be looked after ahead of time, the process is made made much easier.
"Advanced care planning is all about having a discussion with a person, family or carer about the person's wishes for their future health care," Professor Clayton told HuffPost Australia.
"If there is a plan in place for how that person will be looked after ahead of time -- as opposed to when they are in the face of a confronting condition or illness -- the process is made made much easier," Professor Clayton said.
And this can be a conversation broached by apt nursing staff.
"I've had experiences where GP's are involved in this conversation and it works much better. But they have many time pressures placed on them," Professor Clayton said. "So we started to think innovatively about how nursing staff can be involved in having this conversation -- and having it earlier.
"There are a lot more nurses working in general practice these days and their ongoing relationship with patients means that they are ideally placed. They are both willing and capable to be involved in these conversations -- they just don't know how."
It starts with a list of ten questions that the nurse can ask the patient to get the discussion started.
Currently in its pilot training stage, the evidence-based tool kit will equip nurses with the skills needed to initiate the conversation in an empathetic and systematic manner.
"It starts with a list of ten questions that the nurse can ask the patient to get the discussion started. This can be incorporated into their routine health assessments," Clayton said.
"There are also tools to help identify people who could be at a greater risk of falling ill quickly, allowing nurses to work through their most important concerns, symptoms and priorities."
An online training program, endorsed by the Australian Primary Health Care Nurses Association (APNA), and one-on-one mentoring with senior palliative care staff will also be available.
For Salleras, who has undertaken the pilot training, the program provides a structured 'safety net' approach towards identifying patient needs.
We are known as nurses for being caring. To feel that you are providing more holistic care is satisfying.
And it will allow for improved engagement with GPs throughout the process.
"Whilst the conversation can be a nurse initiative, everything is monitored by the GP and this is the education that we need for that to progress," Salleras said.
"I can see it as an appealing thing for the GP when they are aware that the nurse has begun asking these questions."
Salleras is hopeful about the prospects of delivering higher quality care.
"We are known as nurses for being caring. To feel that you are providing more holistic care -- as opposed to purely delivering routine assessments and wound checks -- is satisfying," Salleras said.
"Nurses can and should be involved in that identification and planning, and this program provides the tools for that."
Advance training will take place across all metropolitan cities and major regional centres during the next five months.
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