CPD reflective account Open and honest discussions are vital to help the patient determine what is most important to them. An advance care plan is not legally binding, but will be considered if an individual is no longer able to make known their wishes and a best interest decision is needed.


Refusing treatment

Advance care planning A CPD article helped Patricia Briggs to reflect on her role caring for older people The continuing professional development article on advance care planning prompted reflection on my role as a nurse caring for older people, some of whom have progressive neurological conditions. Progression is often unpredictable and this uncertainty can cause considerable anxiety for patients and their families. Cognitive impairment can also affect the individual’s ability to communicate. Formulating an advance care plan that outlines the patient’s care and treatment preferences before anticipated changes in their condition may help alleviate some of their concerns, as it enables them to plan for their future and take more control. This can improve the patient’s quality of life, as well as easing conflict within families and reducing the burden of making difficult decisions. An advance care plan can be initiated by the patient or by those involved in their care. It must be undertaken voluntarily and the individual must have the capacity

to make decisions. As a nurse, I am in a position to support the individual and their family through this process. The issue of establishing an advance care plan should be broached with sensitivity and individuals should not be overwhelmed with information. It is important to anticipate the patient’s future needs, while also respecting their wishes. The plan should be the outcome of a process, through which an individual can reflect on their care and the progress of their condition, and state their wishes for the future.

This reflective account is based on NS777 Kent A (2015) Advance care planning in progressive neurological conditions. Nursing Standard. 29, 21, 51-59.

An individual may decide that they wish to refuse specific interventions and treatments in the event they lose the capacity to make their own decisions. An advance decision to refuse treatment (ADRT) is legally binding and will avert the need for a best interest decision. The ADRT must be in writing, be witnessed and, where life-sustaining interventions are refused, the wording ‘even if life is at risk’ must be included. Expert specialist advice should be sought to enable patients to make an informed decision. A review should be undertaken and documented periodically. An older person may also nominate an individual to act on their behalf in decisions regarding personal health and/or finances under lasting power of attorney. Reading this article has made me aware of the need for further training so that I can initiate the process of advance care planning. I intend to undertake additional reading on the subject and explore this with colleagues NS Patricia Briggs is a staff nurse at Lourdes Community Nursing and Residential Home in Westgate-on-Sea, Kent

Write your own reflective account You can gain a certificate of learning by reading a Nursing Standard CPD article and writing a reflective account. Turn to page 51 for this week’s article and on page 62 you can find out how to present and submit your reflective account.

Visit the RCN Learning Zone The RCN Learning Zone is a FREE online service to help RCN members with their continuing professional development and professional portfolio management. The RCN Learning Zone can be found at www.rcn.org.uk/members/learningzone.php

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Advance care planning.

The continuing professional development article on advance care planning prompted reflection on my role as a nurse caring for older people, some of wh...
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