Self Directed Learning Package - University of Queensland

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66 • The Palliative Approach ToolkitAssigning a substitute decision makerLet’s assume for a moment that Anna’s dementia is only mildand she still has the capacity to make decisions for herself (asassessed and documented by her GP).ActivityRefer, again, to your relevant State or Territorylegislation, regulations or tribunal (hint: guardianshiprelated to advance care planning and substitutedecision making).Thinking PointYou may be called upon to guide residents andfamily members through the maze of advance careplanning. Think about how you would respond tothese questions:In your State or Territory:• What would Anna need to do in order to appoint afamily member as a SDM?• What documents would she need to complete?• What types of decisions could this person NOTmake?• When would they be able to make decisions forAnna?• Under what circumstances does the appointmentof a SDM end?• According to your State or Territory legislation, canAnna have more than one SDM?Advance DirectivesAn advance directive is a document that sets out personalwishes about future medical treatment if a person loses thecapacity to make these decisions.Key Point• An advance directive is only one part of thewhole process of advance care planning. Thevalue of planning is in the ongoing discussion andinvolvement of the resident and their family inregard to making decisions that have an impacton the resident and their rights to dignity andchoice.• An advance directive provides a clear statementof a person’s views about medical interventionand treatment.• This may assist family members, substitutedecision makers, health care providers and othersby giving them insight into a person’s views andpreferences for treatment.• The person writing the advance directive needsthe opportunity to consider current medicaltreatments and technologies and to discussthe matter with their GP and other health careproviders (including you).ActivityA common question is “So what should I write in thisdirective”?Review the example of an advance directive inSelf-directed learning package: Introductory Registered& Enrolled Nurse.Thinking PointHave you thought about what your health care wisheswould (or would not) be if you were incapacitatedor incompetent and unable to make decisions foryourself?
67 • Self Directed Learning Package - Advanced Registered & Enrolled NurseAssisting families with understanding levels of careKey PointResidents and families can only make INFORMEDchoices if they understand what is being said and allthe possible options.In the DVD “All on the same page”, it states that the foundationof ‘good discussion’ revolves around a mutual understanding ofterminology and phrases. Here are some helpful terms that mayfeature in advance care planning discussions.Advance care plan terminology 4TermTerminalIrreversibleIncurablePermanentunconsciousness (Coma)Post comaunresponsiveness (PCUor PSV)ExplanationA condition that will result in death - the resident can reasonably beexpected to die from the disease.A condition that is unable to be turned around - there is no possibility thatthe resident will recover e.g. motor neurone disease.A condition which has no cure.A condition whereby brain damage is so severe that there is little or nopossibility that the resident will regain consciousness.An irreversible condition by where wakefulness and sleep cycles are present,as well as other bodily functions, but the person is totally unconscious,unaware of surroundings and unable to experience pain.Clarifying ‘life-sustaining’ measures 4Life sustaining measuresCardiopulmonaryresuscitation (CPR)Assisted ventilationArtificial feeding andhydrationDialysisWhat occurs at this levelTreatment aimed at providing artificial ventilation (air flow) via mouth, maskto mouth, or tube down the throat to maintain breathing. Cardiac (heart)compression is by pumping compressions to chest or electrical stimulation.(Statistics regarding survival rates may be useful to discuss).A machine (ventilator) is used to assist the resident to breathe, if theycannot breathe spontaneously.Provision of fluid and or liquidised nutrients by artificial means, if theresident is unable to swallow, eat or drink. Feeding occurs via tubes insertedvia the nose, via direct insertion of a tube into the stomach or via a tubeinserted into a vein.Treatment aimed at replacing the function of kidneys i.e. removal of toxicwaste products from the body.
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