Task purpose:
For this assessment task, you will review a case study and present an essay discussing how the registered nurse (RN) may facilitate the process of advance care planning for people with chronic health conditions. You will explain multiple steps of the advance care planning process. You will apply these steps to Bob’s case. Your ability to explain the important considerations in each step of the advance care planning process will help you support people to make informed decisions about their future care, which align with their preferences and values.
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Learning Outcomes:
By the end of the task, you will be able to:
• Integrate the core principles covered in the subject and its pre-requisites, to develop practice knowledge and skills to support comprehensive patient assessment and monitoring across the lifespan while maintaining cultural awareness, respect and sensitivity.
• Discuss the ethical and legal principles of end-of-life support and enduring powers of attorney as they apply to nurse-patient interactions and respecting cultural values and beliefs.
• Discuss the process of advance care planning, as underpinned by the Medical Treatment Planning and Decisions Act 2016.
• Outline how decision-making capacity is determined.
• Discuss review and activation of an advance care plan.
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Task Description:
For this assessment task, you will be required to review a case study and present an essay discussing how the registered nurse may contribute to facilitating the process of advance care planning for people with chronic health conditions.
The National Framework for Advance Care Planning Documents (2021) recognises advance care planning as a “voluntary and beneficial process, in which individuals can think and plan for their future care; that is, care that is required during periods where they cannot make contemporaneous decisions for themselves. It can bring to light an individual’s values, beliefs, and preferences” (p6).
The National Framework for Advance Care Planning Documents (2021) considers three iterative stages of advance care planning:
• Having the advance care planning conversation
• Making an advance care planning document
• Accessing and enacting an advance care planning document
Further, Medical Treatment Planning and Decisions Act 2016 provides a single framework for medical treatment decision making for people without decision making capacity that ensures that people receive medical treatment that is consistent with their preferences and values.
Part 1: Familiarise yourself with the three iterative stages of advance care planning and think about how these might apply to Bob’s situation. Review the medical treatment decision making act and consider how the act might enable Bob to able to create a legally binding advance care directive. Based on the three iterative stages of advance care planning, you are required to write an essay discussing how you would address each stage in relation to Bob’s case. To do this, you will need to read widely by accessing journal articles, government documents and clinical guidelines (if relevant). Your essay should be your own work with the discussion supported by the citation of contemporary evidence from your research.
Part 2: Review the case study of Bob
Please watch this short introduction to Bob, and review Bob’s case as follows.
Bob is a 58 year old male, who was diagnosed with Motor Neuron Disease- Amyotrophic lateral sclerosis type (ALS) 12 months ago. Bob lives at home with his wife Margaret in a suburb of Melbourne. They have two daughters aged 31 and 28 who live close by and are supportive, although they are also busy with their own young families.
Bob was working as an electrician until 12 months ago when he received his diagnosis. Margaret works part-time as a midwife at a local maternity hospital. Since Bob’s diagnosis, Margaret has had to take an increasing amount of time off work to support him at home and to attend medical appointments. Bob and Margaret are beginning to experience significant financial pressure due to these circumstances.
Bob recently had a hospital admission following a mechanical fall, where he was also found to have aspiration pneumonia secondary to dysphagia. Bob was treated with antibiotics and reviewed by a speech pathologist during his admission. Subsequently, Bob was referred to outpatient services (primary healthcare nursing, PT, OT, SP and SW) for therapy and supports to improve physical and social functioning, as well as a case conference family meeting to develop a care plan once all disciplines are engaged and have completed a review. You are a primary healthcare nurse, and you have access to Bob’s MyHealth record.
You are visiting Bob for a review and to plan for his upcoming case conference. As you start talking to Bob, he tells you “I’m worried about what will happen to me and I don’t want to end up with a breathing tube”. Bob then goes on to tell you “Margaret is keen for me to have any treatment that keeps me alive for longer, but I’m worried what that might look like and I don’t know what to do”.
Part 3: Considering the information contained in Bob’s case, write an essay addressing the following points:
1. Based on the information in Bob’s case, what would prompt you to initiate a conversation about advance care planning with Bob? Discuss important considerations for appropriate timing of this conversation with Bob.
2. What are the benefits of Bob engaging in advance care planning, and what might be some of the barriers?
3. How would you as the registered nurse document Bob’s values, preferences, and beliefs, and ensure these could be shared with other members of the multidisciplinary team?
4. Discuss how Bob would appoint a medical treatment decision maker, and how we might decide who to appoint.
5. When might Bob’s advance care plan be reviewed?
6. In what situation would Bob’s advance care plan be accessed and enacted?
(Approximately 250-300 words each)
Proofread your essay before submission and ensure you have cited all sources of information in the body of your essay (in-text) and reference list according to APA 7th ed. The APA 7th ed. guidelines can be found via the University of Melbourne’s library’s home page or by following direct link: https://library.unimelb.edu.au/recite/referencing-styles/apa7.
Ensure you use relevant evidence from a wide range of sources and that all references are cited accurately in your assignment and in the reference list, using APA (American Psychological Association) 7th edition citation conventions.
Use primary sources that are peer reviewed and with the most current information whenever possible.
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Assessment criteria:
Your work will be assessed on:
• Your analysis and explanation of the benefits for advance care planning for Bob, and potential barriers to the process of advance care planning for Bob.
• Your ability to consider the timing of advance care planning conversations with Bob.
• Your identification and exploration of documentation required during the process of advance care planning.
• Your description of the process Bob would engage in, when selecting a medical treatment decision maker
• Your ability to consider when Bob’s advance care plan might be reviewed.
• Your identification of when Bob’s advance care plan would be accessed and enacted.
• The clarity, structure and organisation of your writing and your use of discipline-specific language
• How well you use high quality references to support your writing.
• How well you adhere to APA 7th edition referencing conventions.
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Notes regarding the rubric below:
* Issues with task length: section is either clearly over length, ie more than 10% outside of expectation.
** Non-distracting errors are those which do not impede the flow of reading or deviate the reader from the message by their nature or frequency.
*** Minimum number of references required is stated in the task brief. If minimum number of references has not been met, but the work is otherwise satisfactory in the Evidence of research and citation criterion, the maximum result attainable is 2.5.
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Plagiarism declaration
By submitting work for assessment I hereby declare that I understand the University’s policy on academic integrity and statement on the use of artificial intelligence software. In accordance with these documents, I declare that the work submitted is original and solely my work, and that I have not been assisted by a third party (collusion) apart from where the submitted work is for a designated collaborative task, in which case the individual contributions are indicated. I also declare that I have not used any writing tools or sources without proper acknowledgment (plagiarism). Where the submitted work is a computer program or code, I further declare that any copied code is declared in comments identifying the source at the start of the program or in a header file, that comments inline identify the start and end of the copied code, and that any modifications to code sources elsewhere are commented upon as to the nature of the modification.
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