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All answers to these online exercises must be entered into the Module 13 Online learning module drop box.
Access the Australian Institute of Health and Welfare (AIHW) website to find out more about the incidence, prevalence, morbidity and mortality risks associated with the four conditions: myocardial infarction, prostate cancer, stroke and type 2 diabetes.
Australian Institute of Health and Welfare, ‘Risk factors, diseases and death’, http://www.aihw.gov.au/risk-factors-diseases-and-death/
Discuss this in 400 words.
A patient’s personal values underpin his beliefs and guide his decisions. The nurse caring for such a patient is guided by the values of his profession, which are expressed in the ANMC Code of Ethics for Nurses in Australia.
What values from the Code do you think are most relevant here?
Australian Nursing & Midwifery Council, Code of Ethics for Nurses in Australia, http://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CB8QFjAA&url=http%3A%2F%2Fwww.nursingmidwiferyboard.gov.au%2Fdocuments%2Fdefault.aspx%3Frecord%3DWD10%252F1352%26dbid%3DAP%26chksum%3DGTNolhwLC8InBn7hiEFeag%253D%253D&ei=jWHdVLr3EsTamAX91oCgBQ&usg=AFQjCNGoKmCj7fYBIvSVAp742-CL3oguwQ&sig2=S96O42nndSoGsOvjjUmqzg&bvm=bv.85970519,d.dGY
Section 7: Nurses value ethical management of information.
Nurses are aware of, and comply with, the conditions under which information about individuals – including children, people who are incapacitated or disabled or who do not speak or read English – may or may not be shared with others. Nurses respect each person’s wishes about with whom information may be shared and preserve each person’s privacy to the extent this does not significantly compromise or disadvantage the health or safety of the person or others. Nurses comply with mandated reporting requirements and conform to relevant privacy and other legislation.
Note: this Code of Ethics is supported by, and should be read in conjunction with, the Code of Conduct for Nurses in Australia and the Australian Nursing and Midwifery Council National Competency Standards for the Registered Nurse, National Competency Standards for the Enrolled Nurse and National Competency Standards for the Nurse Practitioner.
Patients’ personal information is mostly unknown to the doctors and nurses who have cared for them during their contact with the health system. One reason for this is that most health assessments do not entail asking patients about their values and beliefs, or their wishes about the limits to continued treatment, such as CPR. Read ‘The value of taking an ‘ethics history’ by Sayers et al. (2001), and discuss what taking an ’ethics history’ might entail in 400 words.
Sayers, G, Barratt, D, Gothard, C, Onnie, C, Perera, S & Schulman, D 2001, “The value of taking an ‘ethics history’”, Journal of Medical Ethics, vol. 27, no. 2, pp. 114-117, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1733372/
A study by Tulsky, Chesney and Lo (2005) found that conversations between doctors and patients about CPR preferences and options took about ten minutes and missed key information such as the likelihood of surviving CPR. Visit the website Respecting Patients Choices (supported by the Department of Health and Ageing). It has excellent state-based information and resources on advanced care planning: http://www.respectingpatientchoices.org.au/ and so does the SA Health website: http://www.sahealth.sa.gov.au/wps/wcm/connect/Public+Content/SA+Health+Internet/Clinical+resources/Advance+care+directive.
How do you explain the findings of Tulsky Chesney and Lo (2005)?
Do you think that nurses should be involved in making CPR decisions, or is this outside the scope of nursing practice? Explain.
In Victoria, patients can fill out a refusal of treatment certificate (see http://www.publicadvocate.vic.gov.au/file/file/Medical/Refusal_of_Medical_Treatment.pdf.
This option is not available in New South Wales. New South Wales has three relevant policy documents:
Using Advance Directives
End-of-life Care and Decision-making
CPR-Decisions Relating to No Cardiopulmonary Resuscitation Orders.
Identify what laws and policies apply in South Australia.
The NSW Ministry of Health policy on Using Advance Care Directives lists (on p. six barriers to advance care planning. What are they?
This document also identifies (on pp. 6 and 7) a number of best practice recommendations pertaining to advance care directives. Which are most relevant to patients’ situations?
What does the law say about the need for refusal of treatment decisions to be informed?
Assuming a patient does have decision-specific capacity, does he then have the legal right to refuse CPR?
What might the potential legal consequences be of instigating CPR knowing a patient has refused it, but in the absence of any documentation?