A composite model of palliative care for the UK.

This paper argues that there has been a paradigm shift in recent times in the service needs for palliative care as a result of the UK's National Health Service internal market structure, the shift to community care and the rising needs of the private sector. Nursing models associated with palliative care are reviewed and represented within the 'Composite Model of Palliative Care' which blends current and traditional models of care, focusing upon a multidisciplinary approach involving professionals, family and friends. The roles of advocate, manager, educator, carer/therapist, researcher and communicator/counsellor are presented as the vehicle to implement the model of care through a learning contract and associated clinical supervision. The paper also argues that there is a need for specialist palliative care courses at least at diploma level, with appropriate professional recognition, designed to make the paradigm shift and to project this into clinical practice through a tripartite learning contract involving specialist tutor, clinical supervisor and student. The rationale and outline of the course are presented along with the argument that this paradigm shift needs to take place if palliative care is to be truly holistic care.