Guiding Decisions About End-of-Life Care, 2009 - College of Nurses ...

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8Practice GuidelineAppendix A: Supporting NursingPracticeAll nurses, including employers, researchers andeducators, must demonstrate the knowledge, skill,judgment and attitude26 required of regulatedhealth professionals. Nurses must also reflectand understand their roles in improving theirpractice settings and advocating for qualitynursing care practices. Nurses, nurse employersand organizations have a shared responsibility tocreate safe practice environments in which to deliveroptimal health care.To support safe and effective treatment and end-oflifecare practices, nurses in all roles as well as theiremployers, educators and related organizations can:■facilitate nursing staff involvement in developing,implementing and evaluating policies andprocedures, such as helping nurses advocate onbehalf of clients;■provide access to evidence-based information;■ensure that staff orientation includes informationabout end-of-life care issues relevant to thepractice setting;■help other nurses meet the College’s practiceexpectations as well as their organization’spolicies;■support nurses in the development of relevantcompetencies;■initiate continual quality improvement activities;■recognize the need for, and facilitate, debriefing asappropriate;■identify and acknowledge nursing excellence inproviding care to clients; and■advocate for ways to implement evidenceinformedpractices.Appendix B: Legislation Relevant toNursing Practice and End-of-Life CareNurses are expected to practise in accordance withthe College’s practice documents as well as relevantlegislation. To make safe and ethical decisions whenproviding end-of-life care, it is important for nursesto know and understand current legislation that isrelevant to treatment(s) and end-of-life care suchas the Health Care Consent Act, 1996 and SubstituteDecisions Act, 1992.The following are some of the major features of thelegislation:a) Under the Health Care Consent Act, 1996,resuscitation is considered to be a treatment.There is no legal requirement to obtain aphysician’s written, telephone or verbal DNRorder.27b) The Health Care Consent Act, 1996 and SubstituteDecisions Act, 1992 enable a capable person tocreate an advance directive. Through an advancedirective, the person can indicate the kinds oftreatment he or she would like to be acceptedor rejected in the event that the person becomesincapable. If the person becomes incapable, thesedirectives would be interpreted by the person’ssubstitute decision-maker;c) Under the Health Care Consent Act, 1996, a client’swishes about treatment may be expressed in:■a power of attorney for personal care;■any written form;■a verbal form; or■any other manner (such as sign language).In addition, a client’s wishes about treatment:■can be changed at any time (nurses mustrespect the most current wishes and ensurethe client has given informed consent for thetreatment choice); and■are to be interpreted by the client’s substitutedecision-maker if the client is found to beincapable; and the wishes do not constituteconsent or refusal of consent.2826 For more information, refer to the College’s Professional Standards, Revised 2002 practice document at www.cno.org/publications.27 Although there is no legal requirement for a DNR order, organizations may have policies and procedures in place to direct nursingpractice.28 Refer to the Health Care Consent Act, 1996, at www.e-laws.gov.on.ca.College of Nurses of Ontario Practice Guideline: Guiding Decisions About End-of-Life Care, 2009
Practice Guideline9ReferencesCanadian Hospice Palliative Care Association.(2002). A model to guide hospice palliative care:Based on national principles and norms of practice.Retrieved August 6, 2009, from http://www.chpca.net/norms-standards/model_to_guide_hpc.html.Canadian Nurses Association. (2008). PositionStatement. Providing nursing care at the end oflife. Retrieved July 10, 2009, from http://www.cna-aiic.ca/CNA/documents/pdf/publications/PS96_End_of_Life_e.pdf.Dunbrack, J. (2006). Advance care planning: Theglossary project. Retrieved July 10, 2009, from http://www.hc-sc.gc.ca/hcs-sss/alt_formats/hpb-dgps/pdf/pubs/2006-proj-glos/2006-proj-gloss-eng.pdf.Health Canada. (2002). National planning workshopon end-of-life care. Retrieved May 27, 2009, fromhttp://www.hc-sc.gc.ca/hcs-sss/pubs/palliat/2002-nat-plan-palliat/index-eng.php#introduction.Health Canada. (2007). Canadian strategy onpalliative and end-of-life care: Final report.Retrieved May 27, 2009, from http://www.hc-sc.gc.ca/hcs-sss/pubs/palliat/2007-soin_fin-end_life/intro-eng.php.College of Nurses of Ontario Practice Guideline: Guiding Decisions About End-of-Life Care, 2009
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