Reference no: EM133864901

CASE STUDY: ADVANCE CARE PLANNING

Judy is 53 years old and the daughter of Elizabeth, aged 80. Elizabeth has recently fallen and fractured her hip. Her hip was repaired in the local hospital's orthopaedic ward a week ago and she is now in the rehabilitation ward. Elizabeth has been a widow for the past five years and lives twenty minutes away on the other side of town from Judy. Elizabeth's other two children, Rob and John, are farmers who live with their families in a farming district approximately 600km away. Before Elizabeth can be discharged, the healthcare team asks you who might be able to support Elizabeth during her recovery at home. You mention that her daughter Judy seems to be the person that Elizabeth relies upon the most, and a family meeting is arranged to discuss Elizabeth's prognosis and care after discharge.

To ensure that Judy is the person that Elizabeth prefers for managing her care, the discharge team asks Judy if her mother has made any advance care directives such as a Healthcare Power of Attorney or Power of Guardianship. Judy recognises the terms and remembers that she and her mother created these documents for Judy's father in the last year of his life but to her knowledge they have not made any for Elizabeth. The social worker suggests that Judy discuss with Elizabeth creation of these documents to formalise the care management arrangements. The social worker also suggests that Judy consider these documents for herself.

Before she is discharged, Elizabeth confides to you that she is concerned she will not be able to manage on her own. She describes how lonely she has been since Judy's father died and that this has increased since Judy took on the part-time bank job. You alert Judy to the fact that her mother is concerned about managing at home on her own. That evening, Judy and Elizabeth have a heart-to-heart conversation.

Elizabeth tells Judy that she never wants to be placed in a nursing home and has also made it clear that she doesn't want any medical interventions if she suffers a stroke or heart attack. After this conversation, Judy asks you how she can make sure Elizabeth's requests are honoured. You begin to recognise that Judy and Elizabeth are engaging in advance care planning.

QUESTIONS:

1. How do you assist Judy and Elizabeth in their advance care planning?

2. What are the legal instruments known as advance directives in your state or territory?

· What names are they called?

· When should they be brought into play?

· Which ones nominate a substitute decision-maker?

· What is the role and scope of the substitute decision-maker for the different instruments?

3. Would you be comfortable engaging in advance care planning conversations with Judy and Elizabeth?

- If so, why?

- If not, why not?

4. What skills, knowledge and attitudes will the nurse providing this assistance need to have?

5. What information would you provide to Judy and Elizabeth about:

- The benefits to creating advance directives

- The risks of creating advance directives

- The benefits and risks of being a substitute decision-maker

6. Where else could you refer Judy and Elizabeth for advice on advance directives and advance care planning?