Clinician Profile – Anna Nolan, Parkinson’s Disease Nurse Navigator

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Living with a complex chronic disease can leave patients feeling alone and bewildered as they try to find their way through the healthcare system. For a very individual “boutique” condition like Parkinson’s disease, a patient’s journey can be made even harder because each person is forging their own unique way. There are broad paths of similarity as the disease progresses, but patients can’t predict which symptoms they will get, and when they will get them. 

Parkinson’s disease is a progressive, degenerative neurological condition that affects a person’s control of their body movements. After dementia Parkinson’s is the next most common neurological disease in Australia with more than 17,000 Queenslanders, from all walks of life, living with the disease. Currently there is no definitive diagnostic test and no known cure.

CKN spoke to Anna Nolan RN, one of the dedicated clinicians helping to guide patients through often confusing Parkinson’s maze. Drawing on her background and expertise in neurology, Ms Nolan is supporting patients in her role as Princess Alexandra Hospital’s first Parkinson's Disease Nurse Navigator – a role designed for this special group of patients with complex health needs, requiring a high degree of comprehensive, clinical care. 

Prior to her present role, Ms Nolan spent three years at the Royal Brisbane Women’s Hospital firstly in the Stroke and Neurology Ward, then as the Clinical Nurse Coordinator for Neurology Outpatients. Moving to Princess Alexandra Hospital in 2015 Ms Nolan started as the Movement Disorders Specialist Nurse for Neurology Outpatients, and establishing the first nurse-led Movement Disorder Clinic in Queensland. This progressed to her current role as Parkinson’s Disease Nurse Navigator, in January of this year, while also completing a Postgraduate course in Neuroscience Nursing.

Ms Nolan holds an Advanced Programming for Deep Brain Stimulation Nurse Specialists qualification from the United Kingdom (2017-18). She was the only Australian Clinical Nurse sponsored to attend last year’s International Movement Disorders conference held in Canada. She was nominated for Princess Alexandra Hospital’s 2017 Nurse of the Year. Her Movement Disorders team (consisting of Dr Alexander Lehn and herself) was nominated for the Princess Alexandra Hospital’s 2016 Board Chair Awards for “Team of the Year”, and the 2016 Premiers Award for excellence in the category of customer focus.

“It’s a life-long journey and I’m here to make sure our patients don’t feel
confused, lost or helpless.” 

In the Movement Disorders Unit at Princess Alexandra Hospital we look after patients with disorders such as Parkinson’s disease, tremors (uncontrollable shaking) and dystonias (where a person’s muscles contract uncontrollably for prolonged periods of time). These disorders can be extremely disabling, but with modern multi-disciplinary management they can often be well treated. 

It’s important that patients and their carers are connected to the right support and care and my role as Parkinson's Disease Nurse Navigator is to help guide people with Parkinson’s disease through the numerous specialty areas and where possible to avoid any unnecessary trips to hospital. 

When I started at PAH in November 2015 I set up the “Movement Disorders Hotline”. Patients and their families can ring up and get help straight away with the often difficult and complex issues they might have as part of their disease – dealing with the management of ongoing symptoms, medication side effects, sleep problems, DBS hardware issues, psychiatric issues and cognitive issues. When our patients start new medications or have other changes to their therapy they receive follow up phone calls to ensure they don’t have any problems and actually get the benefit we are hoping for. If there are small issues I can solve them on the spot, or otherwise liaise with the consultants in the unit as well as other health professionals involved to make sure that our patients get the very best care that they deserve.

It’s an innovation that has been an important part of facilitating the patient journey through caring communication. It helps to reduce unnecessary emergency department presentations or hospital admissions, and has also cut waiting times for people to see a movement disorder specialist or a general neurology consultant. The increasingly complex management of the disorders we treat is often too difficult for GPs to deal with as well, and this provides them with a critical service. 

I’ve been involved with other movement disorder initiatives, including setting up and managing the Movement Disorder Clinic and the Deep Brain Stimulation (DBS) unit at PA Hospital, which is the first public DBS program available in Queensland. I’m also involved in the set-up of the Gamma Knife Clinic which is the only public hospital program of its type available in Australia. 

In the Movement Disorder Clinic I see up to 15 movement disorders patients every week for ongoing review and management. This has directly reduced the number of people on the Neurology outpatient department’s long waiting list. My eventual aim is to ensure every patient requiring a movement disorders review is seen within the clinically recommended timeframe. Throughout all of my patient-centred consultancy practice I encourage people with Parkinson’s to actively participate in their treatment, along with all the stakeholders including primary and tertiary practitioners.

To further support my neurology outpatients, with Dr Alexander Lehn’s guidance, I have created a 63 page Parkinson’s disease information booklet which is available to all newly diagnosed patients. The booklet covers a broad range of topics related to Parkinson’s Disease, such as the role of Dopamine, disease etiology, autonomic nervous system and neuropsychiatric changes, medications available to treat Parkinson’s, support groups (e.g. Parkinson’s Disease QLD), the services that are available for public access (patient travel subsidy support, continence aids scheme etc) as well as end of life planning. 

I have recently developed numerous information sheets relating to side effects caused by medications that are commonly prescribed for those who suffer from progressive neurological conditions. These are given to the patient upon being prescribed their new medication, giving them important information, which can help them and their carers to monitor and understand common side effects and be aware of potentially life threatening side effects. 

I often use CKN resources such as MIMS Online and Australian Medicines Handbook to help with my practice. Both resources provide an updated source of drug information which is useful particularly when seeing patient’s in an outpatient’s setting as you have a set timeframe you need to see your patient within and being able to source reliable information quickly is very handy. For example, I was seeing a patient with Parkinson’s disease in my clinic for their annual movement disorders review. They kept telling me that during the past month they had noticed that their Sinemet (carbidopa levodopa) medication wasn’t lasting as long as it previously had been. The patient went onto tell me that she had just started on a regular iron tablet so I was able to use MIMS Online to look up the drug interactions for Sinemet which showed that carbidopa may have its absorption decreased by ferrous sulphate. With the use of MIMS Online in this instance a lot of further clinical investigations and tests were prevented. 

CKN’s research databases including CINAHL Complete, Clinical Key and Clinical Key for Nursing, Cochrane Library, MEDLINE Complete and PubMed are also in regular use.
Having the latest evidence is very important to my work. I need to know how to apply advanced knowledge of contemporary, nursing practice and theory in the coordination and delivery of holistic, multidisciplinary patient centred care using evidenced-based integrated care pathways. Nurses are the largest segment of the health care workforce and patients’ primary professional caregivers. Our education and training directly affects the safety and quality of patient care. However, the Australian healthcare system is evolving and patients’ needs are changing. The population is living longer and becoming more diverse and health needs are becoming more complex. Increasingly, we work in teams of providers drawing on different areas of expertise and health care technology is advancing rapidly. As emerging nurse leaders and new graduates enter the workforce I think we need to take advantage of them having grown up in the digital world and use our skills to empower other nurses with confidence to use the digital systems we have at our disposal.  

Ultimately I hope to make quality evidence based system improvements that will benefit my patient’s experiences and outcomes. There is currently no known cure for Parkinson’s, but there are many treatments available. Dr Lehn and myself in the Movement Disorders Unit are really dedicated to developing initiatives that benefit all Queensland neurological patient outcomes, and improving the care of the patients we see - sometimes that just means being someone to talk to.

Anna Nolan
RN, Parkinson's Disease Nurse Navigator
Princess Alexandra Hospital