Self Directed Learning Package - University of Queensland

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124 • The Palliative Approach ToolkitDoes advance care planning have to be alegal process?It is not compulsory to complete a legal form. Not all residentsare willing (or able) to complete a legal document such as anadvance directive.The Good Palliative Care Plan, developed in South Australia isan alternative option. It can be used in any state or territoryand while not legally binding provides opportunity fordocumenting the outcomes of a discussion about the resident’scurrent condition and goals of care. Table 2 provides a segmentof this document.Table 2Excerpt from the Good Palliative Care Plan 8Circle one of the options:We have agreed that in the event of further deterioration in thepatient’s condition:1. Full cardiopulmonary resuscitation with total body support asrequired will be undertaken.2. Intensive medical support will be undertaken, butcardiopulmonary resuscitation will not be initiated, and nolong-term support measures, including ventilation or dialysis,will be undertaken.3. The emphasis of management will be on Good PalliativeCare, highlighting the relief of symptoms and discomforts.No artificial measures designed to supplant or support bodilyfunction will be undertaken.4. Other. Please specify:What if a resident is no longer able to expresstheir wishes?Thinking Point• Bob was able to make his own decisions and putthese in writing. Unfortunately, not everyone wantsto do this or is able to.• If Bob had advanced dementia and could notexpress his wishes about future care, what shouldhappen?• Should Bob be sent to hospital even if his familysay it was not what he wanted?Key PointIf a resident is not competent to make decisionsfor themselves, they cannot complete an advancehealth directive or legally appoint someone toadvocate on their behalf.This does not mean that they cannot be involved indiscussions about their advance care planning.It is also worthwhile considering the family’s viewson what the resident would have wished.What is my role as a careworker?Residents and family members often become close tocareworkers and may mention issues related to advance careplanning with you. Sometimes what seems like a ‘throw away’comment e.g. ‘I wouldn’t want to live like that’ may be importantto follow up.Ask the resident and/or family member if they would like to talkto a nurse about their concerns, and report back to the nurse sos/he can arrange a meeting. Be alert for any ongoing concerns aresident may raise.Thinking PointHas a resident or family member ever talked to you aboutthe resident’s end of life care wishes? How did you handlethis? Did you report this information to a nurse? Is thereanything you would do differently next time?
125 • Self Directed Learning Package - CareworkerDyspnoeaDyspnoea is an awareness of uncomfortable breathing.It can also be called breathlessness or shortness of breath.Thinking PointHave you ever had the experience of not being ableto breathe well? Perhaps after a strenuous exercisesession? Can you imagine living with that sensationconstantly? If you have, what thoughts or feelingscome to mind?SeeRecognise and assessKey PointDyspnoea is not so much about how fast or slow,deep or shallow someone is breathing. Rather itis a subjective feeling that everyone experiencesdifferently.The Australian author Tim Winton wrote in his 2008 novel‘Breath’: 12‘It’s funny, but you never really think much about breathing,until it’s all you ever think about.’Dyspnoea• is common but under-recognised• impairs activities of daily living, limits mobility, increasesanxiety, fear and social isolation• is often associated by residents and family withimpending death• triggers panic, and panic exacerbates dyspnoea, so thepattern becomes cyclical• may be equally or even more distressing for the family.So… what can you do to help a resident with dyspnoea?Because health professionals often under-report dyspnoea theresident should be encouraged to rate the severity themselves(if able to do so).Verbal Rating ScaleAsk: ‘On a scale of zero to 10, with zero meaning nobreathlessness and 10 meaning the worst breathlessnesspossible, how much breathlessness do you have right now?’Please noteWhile dyspnoea is the term health professionals use, it is betterto refer to it as breathlessness when talking to residents orfamily members.For those residents who cannot communicate, take time toobserve their breathing rate and any resulting impact on theirmood, sleep or function.
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