Challenges in advance care planning: the interface between explicit instructional directives and palliative care

Abstract

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Palliative Care Nursing in Australia and the Role of the Registered Nurse in Palliative Care

“…The NSQHS standards Action 5.14 expands on using comprehensive care plans to monitor efficacy of actions, review, reflect, update, reassess efficacy, and institute care plan changes if the patient’s condition changes. This is commensurate with NMBA standards 1.6, 2.8, 3.7, 4.1, 4.2, and 7 [ 8 , 9 , 22 ]. The NSQHS Standards Action 5.14 and NMBA Standard 7 are to be consistently demonstrated by palliative care nurses via evaluating, recording, investigating, revising care plans, and managing a palliative patient’s deterioration [ 8 , 9 , 10 , 22 ].…”

“…This is commensurate with NMBA standards 1.6, 2.8, 3.7, 4.1, 4.2, and 7 [ 8 , 9 , 22 ]. The NSQHS Standards Action 5.14 and NMBA Standard 7 are to be consistently demonstrated by palliative care nurses via evaluating, recording, investigating, revising care plans, and managing a palliative patient’s deterioration [ 8 , 9 , 10 , 22 ]. Factors such as dehydration, infection, polypharmacy, iatrogenic issues, endocrine issues, deranged blood tests, constipation exacerbation, psychiatric manifestations, and renal/cardiovascular issues must be ruled out before a thorough multidisciplinary team assessment is done.…”

“…A palliative care RN should have specific attributes, abilities, and training as posited in the NMBA nursing standards [ 7 ]. Some of the important ones are standards 1.1/1.4/6.5 (evidence-based nursing and law-/rules-compliant), 1.5 (ethical practice), 1.6 (thorough documentation of interventions and evaluations), 2.2/2.5 (apt communication, patient autonomy, and advocacy), 2.8 (multidisciplinary integrated care and consultative nursing), 2.9/6.6 (prompt reporting of poor clinical practice), 3.4 (accept accountability for decisions), 3.7 (health promotion towards good outcomes), 4.1/4.2 (do holistic assessments), 5 (planned clinical practice), 6.1/6.2 (practice withing scope and safe responsible nursing), and 7 (evaluates condition/changes versus goals, records, communicates, and revises care plan as recommended) [ 8 , 9 , 10 ].…”

“…The ACD comprises binding instructions and/or preferences on topics such as treatment venues, final rites, life-prolonging treatments (like intubation or ventilator support), and cardiopulmonary resuscitation [ 17 ]. Legislation permits an official MTDM to be appointed to a cognitively competent patient in the presence of two witnesses if the patient’s cognition is expected to be lost subsequently [ 9 ]. An MTDM can make treatment decisions for the patient if he/she loses the capacity to make them on the person’s behalf if they do not have capacity to make the decision [ 18 ].…”