Nurse Navigator, Home Based Palliative Care Outreach Services, Hospital

Aga Khan University Hospital

The Aga Khan University Hospital, in addition to its five Hospitals, creates access through its Outreach Services which include Clinical Laboratories, Outpatient Medical Centres, Pharmacy services, Home Health, and other services. Outreach Services are designed to provide primary to secondary healthcare services to patients near their homes and are present in several cities across Pakistan. Outpatient Medical Centres offer a range of specialty clinics including Family Medicine, Internal Medicine, Endocrinology, Dermatology, Gastroenterology, Cardiopulmonary, Orthopedics, Obstetrics and Gynecology, Pediatrics, and Physiotherapy, catering to children, adults, and elderly patients for general health checks or specific disease consultations.

As an equal opportunity employer, AKU believes in promoting a diverse and inclusive culture and is committed to adopting appropriate standards for safeguarding and promoting a respectful relationship with and between the diverse workforce of its faculty, staff, trainees, volunteers, beneficiaries, wider communities, and other stakeholders with whom it works, including children and vulnerable adults.

You will be responsible to:

• Meet with every newly diagnosed patient after the treatment plan has been formulated by the clinician(s) and reiterate the plan, assess patient needs and understanding of this plan upon initial encounter and periodically throughout navigation, matching unmet needs with appropriate services and referrals and support services, such as dieticians, pharmacy, physiotherapy providers, support groups, and financial assistance.
• Develop and use appropriate assessment tools to promote a consistent, holistic plan of care.
• Assess educational needs of patients, families, and caregivers, taking into consideration barriers to care (e.g., literacy, language, cultural influences, comorbidities).
• Provide and reinforce education to patients, families, and caregivers about diagnosis, treatment options, side effect management, and post-treatment care with the help of brochures, educational material, web resources, and protocols.
• Perform detailed counseling of patients and families before the initiation of the plan of care.
• Support a smooth transition of patients from active treatment into survivorship or end-of-life care.
• Provide psychosocial support and facilitate appropriate referrals for patients, families, and caregivers, especially during periods of high emotional stress and anxiety.
• Serve as the primary point of contact between the Home Health Team and outpatient/family members.
• Work closely with the research officer to maintain records of all newly diagnosed patients and their outcomes in terms of those treated here or referred elsewhere with reasons.
• Participate in coordination of the plan of care with the multidisciplinary team, promoting timely follow-up on treatment and supportive care recommendations.
• In collaboration with other members of the healthcare team, build partnerships with local agencies and groups that may assist with patient care, support, or educational needs.
• Ensure documentation of patient encounters and provided services.
• Manage and handle hotline services within specialty and maintain call logs for reference.
• Assess and develop teaching material based on need and best practices.
• Provide facilitation for nurses and staff working in home-based services for specialty-based training.
• Conduct audits on a need basis to bring improvement to services such as documentation.
• Able to work and collaborate on care needs with the multidisciplinary team.

You should have:

• BScN / MBBS from a recognized nursing institute/Medical degree/Allied sciences.
• Minimum 2 years of experience as a clinical provider.
• Valid registration from Pakistan Nursing Council/PMDC/or applicable.
• Good interpersonal and communication skills.
• Sound clinical knowledge and competencies in specialty-specific site.
• Persuasive skills to manage patient counseling effectively.

Comprehensive Employment Reference Checks will be conducted.

You should send your updated CV to human.resources@aku.edu and mention the position applied for in the subject line.

Only shortlisted candidates will be contacted.

Applications should be submitted latest by February 15, 2025.