Self Directed Learning Package - University of Queensland

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16 • The Palliative Approach ToolkitDoes advance planning have to bea legal 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 territory andwhile not legally binding provides opportunity for documentingthe outcomes of a discussion about the resident’s currentcondition and goals of care. Table 2 provides a segment of thisdocument.Table 2Excerpt from the Good Palliative Care Plan 9Circle 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 PointBob was able to make his own decisions and putthese in writing. Unfortunately, not everyone wants todo 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 family sayit 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 nurse?Residents and family members often become close to nursesand careworkers and may mention issues related to advancecare planning with you. Sometimes what seems like a ‘throwaway’ comment e.g. ‘I wouldn’t want to live like that’ may beimportant to follow up.Encourage the resident and/or family member to discuss theirconcerns. Be alert for any ongoing concerns a residentmay raise.Thinking PointHas a resident or family member ever talked to youabout the resident’s end of life care wishes? Howdid you handle this? Is there anything you would dodifferently next time?
17 • Self Directed Learning Package - Introductory Registered & Enrolled NurseDyspnoeaDyspnoea is an awareness of uncomfortable breathing. It canalso 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?The Australian author Tim Winton wrote in his 2008novel ‘Breath’: 15‘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?SeeRecognise and assessReview previous medical history• pre-existing illnesses e.g. COPD• exacerbating factors e.g. anaemia or profound anxiety• additional factors e.g. pulmonary embolism, infection or leftventricular failure.Associated symptoms• cough• sputum• haemoptysis (blood in sputum)• wheeze• stridor• pleuritic pain• fatigue• anxiety or panic.What makes it better or worse?Observe or ask the resident:• physical activity?• posture?• environmental factors? (e.g. room sprays, pollen)• emotional factors? (e.g. anxiety, excitement, fear)• others?Key PointDyspnoea is not so much about how fast or slow,deep or shallow someone is breathing. Rather itis a subjective feeling that everyone experiencesdifferently.As a nurse, you should be able to complete anddocument a comprehensive baseline assessment of anyresident who presents with dyspnoea.
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Self Directed Learning Package - University of Queensland

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