Primary or community neurological support is an area of increasing need, of significant health expenditure, of complexity, and of chronicity. It could be asserted that existing Western Australian community support services have developed in an ad-hoc manner not using any planned, collaborated, coordinated or articulated strategy.
It is estimated that about one in six consultations in primary health care relates to a nervous system or neurological symptom of some kind and about one in five emergency admissions to hospital are due a neurological illness; however, many of these cases are managed entirely within the community (Action on Neurology, 2005).
Simons (2008) states, “a patient with a neurological condition spends roughly three hours per year with an acute based health professional. The other 8757 hours the person manages their own condition with community support, thus community based support networks and meaningful social connectivity is crucial”.
The focus on neurological conditions and the recognition of their impact on an ageing population is increasing worldwide (Public Health Agency of Canada, 2014). Murray and Lopez (1996) state that neurological diseases, disorders and injuries, referred to collectively as neurological conditions also contribute to a greater burden of disease than previously thought. Consideration is needed therefore on how this need is going to be met in the future.
The community base for neurological care delivery illustrates why the identification of effective community neurological service models is important. Giles and Lewin (2008) researched the needs of adults with neurodegenerative disorders and concluded that continuing to live in the community was the primary goal for most study participants.
The literature clearly conveys the value and function of the traditional disease or diagnosis specific community nurse support model as well as evidencing the skill set and impact these roles have on supporting the patient in their own home. It could be argued that the role of the nurse is well understood and accepted by both the public and health professionals. Due to this understanding they are well placed to act as the conduit between the two, ensuring clarity and understanding of changed health status, as well as reinforcing treatment plans and ensuring that actual and potential problems are identified, supported and managed.
Within Western Australia a generic community neurological nursing model has been developing with the Neurological Council of Western Australia (NCWA) leading this innovation. The NCWA through the Neurocare program has for a number of years facilitated regional generic community neurological nurses with a skill set and competency level enabling them to support all those with neurological need, this service has developed further with a profile now also within the Metropolitan regions.
A generic neurological nurse has specialist skill and competency in the broad area of neurological nursing. The focus of their therapeutic approach is on the individualised and holistic wellbeing of the client/patient, regardless of neurological diagnosis or symptom impact. This role has a real focus on ensuring all neurological clients/patients have the right support at the right time with a major focus on Vital Integration Points (VIPs). VIPs are times when it is crucial that actions or linkages are made in a timely and managed manner to ensure that the client/patient support journey continues in a successful or impactful way. It is at these key communication points that things can break down and the community Neurological Nurse pays a key role in coordinating and reinforcing the management plan.
Traditionally the neurological service models within WA have developed over the past decade with a defined diagnostic specific scope and geographical boundary. It could be argued this has created inequity for those clients/patients who cannot access these defined and specific community support services. The Neurocare generic community neurological nurse role and model has a focus on equity, accessibility providing education, advice guidance and support of treatment plans. The emphasis of the model is on the holistic need of the client/patient rather than the diagnostic label; it could be argued this is true client/patient centered care. The Neurocare model has significance as a contemporary model with potential for reproducibility in other areas of WA and Australia.
There is limited understanding of neurological need and application of knowledge in regards to service planning and appropriate community service models. Given the anticipated increase in neurological need and the changing focus to the “community” as the setting for support and care knowledge is needed to determine the most appropriate service delivery model for WA. Chiarella (2008, p 3) states “the current model of disease based focused services that are the dominant theme in Australia even in community care is unsustainable” for these reasons fresh thinking is needed on how knowledge and skill can be framed to facilitate greater reach and impact on client/patient outcomes. NCWA Neurocare model can deliver in this regard.
The NCWA model is currently being evaluated by a research team at Murdoch University led by Professor Anne Williams.