Are Advance Care Directives important for nurses?

1. Are Advance Care Directives important for nurses? Penny Williamson PhD Candidate School of Nursing and Midwifery Division of Health Sciences

2. What is an Advance Care Directive? • Describes what type of treatment/care a person might like in different scenarios • Anyone over 18 can make one • Introduces the Substitute Decision Maker • Legally binding document in South Australia

3. Previous forms for SA • Living Will • Enduring Power of Guardianship • Medical Power of Attorney • Statement of Choices • Good Palliative Care Plan • Resuscitation Plan • Do Not Resuscitate form • Respecting Patient Choices • Anticipatory Direction (superseded 2014)

4. Legal Forms around the country • Health Direction (ACT) • Advance Personal Plan (NT) • Direction under Natural Death Act (Superseded 2014 – NT) • Advance Health Directive (Qld) • Enduring Guardianship (Tas) • Refusal of Treatment Certificate (Vic) • Advance Health Directive (WA)

5. Prevalence of Advance Directives in Australia Taken from White et al. (2014) pp. 978, Table 2

6. What does SA recognise? Taken from Carter et al. (online first) pp. G, Table 5

7. What other states recognisethe SA ACD? Taken from Carter et al. (online first) pp. G, Table 5

9. Previously…..

10. Now…..

12. So why am I telling you this?

13. Broad Research Question How do advanced care directives direct end of life care in an Emergency Department context?

14. Methodology and Method Methodology: Naturalistic Method: Two studies • Descriptive Study • Document Analysis

15. So what have I done? • Interviews with Emergency Department Staff • Medical Officers (13) • Nursing Staff (51) • Others (3) • Collected documents to analyse what information available • Individual hospitals approached about documents they had

16. Some preliminary notions that are emerging from the interviews….

17. Some forms have vague language to describe the kind of care or treatment the person would prefer “not always filled out to what’s clear to us”

18. Patients do not understand procedures or terminology they mentioned on form “a lot of them will say ‘Yes, I definitely want CPR’, but then you explain what CPR is and what the outcome probably is, they’ll say ‘Well, I don’t want that’, so they don’t fully understand”

19. Where are people keeping forms? “they don’t always make it to the case note because they’ve had it done, but haven’t brought it in with them”

20. Access to forms in the hospital system is not straight forward

21. References • White, B., Tilse, C., Wilson, J., Rosenman, L., Strub, T., Fenne, R., & Silvester, W (2014) Prevalence and predictors of advance directives in Australia, Internal Medicine Journal, 44(10): 975-980. • Carter, R., Detering, K., Silvester, W., & Sutton, E (online first) Advance care planning in Australia: what does the law say?, Australian Health Review, A-I. • Advance Care Directives Website: http://www.advancecaredirectives.sa.gov.au/

22. Thank you and Questions