Paper on Analyzing Resuscitation Plans in End-of-Life Decisions: Considerations for Future Healthcare Practices

Overview of Selected Resource

A Resuscitation Plan (RP) is the selected resource for this assessment. A resuscitation plan is a standard double-sided, colored sheet used by NSW health organizations. The NSW form captures patients' end-of-life goals, life-sustaining treatments, and refusal of resuscitation. It relates to a particular occurrence of healthcare. The RP is filled by a Medical Officer (MO). The context to be utilized is a 25-bed rehabilitation and aged care ward. It is located in a 200-bed health facility. Naturally, patients are admitted from home through the Emergency Department and receive acute care. Admission of patients often follows after the patient has suffered a stroke, fall, or sepsis. The patients are then transferred for reconditioning and rehabilitation. After admission, patients are required to fill out RP and CPR forms. RP forms are then run against Action 2.6. This action mainly involves clinicians partnering with health practitioners to ensure shared decision-making for future and current care. After the treatment process is completed, individuals are either selected for aged care facilities or discharged.

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Partnering with Consumers and its Influence on Patient Outcomes

Partnering with Consumers is crucial at both service and individual levels (Mulley, Trimble, and Elwyn 2012, p. 67). One main reason as to why the National Safety and Quality Health Service Standard emphasizes on “partnering with consumers” is that patients may have contradictive primacies from their clinician. More so, a community may express opinions that may differ from those expressed by the healthcare organization (Mulley, Trimble, and Elwyn 2012, p. 71). Partnering with consumers comes with numerous benefits. For instance, it ensures that outcomes are documented at both levels. Secondly, it focuses on the patient-clinician relationship that improves the relationship between both groups and aids in establishing a more effective and trustworthy collaboration (Harris et al., 2018).

Another benefit that comes with partnering with consumers is that it is consistent with person-centered care (PCC). A PCC takes into account an individual's hospitality. Person-centered care goes beyond focusing on a patient’s disease and acknowledges psychosocial beliefs, preferences, and values (Edvardsson, Watt and Pearce 2017, p. 220). The literature highlights various PCC benefits. Some of these benefits include pathology inquiries, improved safety and patient satisfaction, reduced readmissions, adherence to treatment plans, and referrals to special treatment (Jo Delaney 2018, p. 120).

How does the Selected Resource Meet the Related Action?

The Adult Resuscitation Plan is supported by the End of Life Decisions policy (EOL). The EOL policy gives insights into the intended use of the NSW form (Edwards et al. 2016, p. 265). The resuscitation policy is fundamentally consistent with Action 2.6, which enables healthcare planning and group decision-making. The setup works to ensure that treatment practices delivered are at their best. More so, it gives the MO the power to state patients’ care. The form also provides an individual with the ability to refuse or consent to specific interventions (Hyde, Bowles and Pawar 2014, p. 8).

Identify how the Resource Meets the Related 'Action'

The Adult Resuscitation Plan comes with a few disadvantages, even though it is a reflection of best practices administered to patients by clinicians (Salins and Jansen 2011, p. 42). For instance, the form’s practical implementation is problematic. The resuscitation plan is physician-medicine-centric. This means that it does not give nurses sufficient backing, although they are often first responders to cardiopulmonary arrests. Another setback as seen with the form is in the patient’s signature. As seen from the RP form, only a medical officer’s signature is required. As such, only one signature between two parties is not a guarantee that dialogue has occurred. Surprisingly, Action 2.6 states that a medical officer can designate an individual ‘not for CPR’ without the patient’s consent. (Arabi, Al-Sayyari and Al Moamary 2018, p. 67).

Action 2.6 insists that details of a CPR form are to be handed over during shifts. However, not all practitioners follow this policy to the letter, and it can, at times, prove unreliable and inconsistent. Besides, the RP form is prone to transcription errors given the fact that it is a text-free field. From the literature, informal meetings with RNs reveal that a majority were aware of an existing RP. This shows that RPs hold for both patients and health practitioners. The policy also gives nurses the ability to document and share information with their patients. However, no training regarding the RP forms is availed to nurses as it is done with medical officers (Edwards et al. 2016, p. 267).

My Considerations for Future Professional Practice

RPs remain a challenging conversation for both medical officers and patients. One particular reason why I found few RPs on the file was that a vast majority of patients either refused to talk about it or were unaware that RPs were also necessary (Cadogan 2010, p. 11). For the case of health practitioners such as MOs and other physicians bearing the responsibility of decision-making is sometimes tricky. For this reason, a majority resort to only completing an ACD.

From the literature, it is evident that the rate of CPR survival to discharge among patients lies between 11% to 15% for individuals aged over 80 (Cadogan 2010, p. 12). Furthermore, the number of survivors who are left with neurological impairments is significantly high. It is important to note that neurological impairment among survivors often leads to long-term institutional care. This low value opposes the likelihood of a positive result (Cadogan 2010, p. 12).

Just as in other medical institutions, NSW physicians are tasked with explaining the odds of survival during EOL discussions. This is even made easier when health facilities are equipped with excellent educational material that endorses an understanding of CPR outcomes (Cadogan 2010, p. 13). Information sharing between physicians and patients is essential in that it aids in making shared decision-making. Therefore, it is imperative that the patient, (if desires) is conversant with the benefits, statistics, and risks that come with the treatment processes (Salins and Jansen 2011, p. 42).

Recognized as physician-centric practitioners, RNs play an essential role in a healthcare setting and may act as a patient’s advocate. From the literature, it is beyond my scope as an RN to initiate End of Life conversations with patients. More so, decision-making and medico-legal responsibilities fall under the most Senior Medical Officer (Edwards et al. 2016, p. 267).

RNs possess numerous functions. For instance, it is acceptable for an RN to make referrals. Besides, an NSW RN may be required to ensure patients do not overinterpret RPs. This is a common cause of inadequate care. When it comes to future practice, scholars are recommending the implementation of 'Goals of Care' which focuses on distressing negative language and reflecting on religious and emotional priorities. 'Goals of Care' also works to highlight possible healthcare interventions (Arabi, Al-Sayyari, and Al Moamary 2018, p. 67).

References

Arabi, Y., Al-Sayyari, A. and Al Moamary, M., 2018. Shifting paradigm: From “No Code” and “Do-Not-Resuscitate” to “Goals of Care” policies. Annals of Thoracic Medicine, [online] 13(2), p.67. https://doi.org/10.4103/atm.atm_393_17

Cadogan, M., 2010. CPR Decision Making and Older Adults. Journal of Gerontological Nursing, 36(12), pp.10-15. https://doi.org/10.3928/00989134-20101109-01

Edvardsson, D., Watt, E. and Pearce, F., 2016. Patient experiences of caring and person-centredness are associated with perceived nursing care quality. Journal of Advanced Nursing,73(1), pp.217-227. https://doi.org/10.1111/jan.13105.

Edwards, B., Stickney, B., Milat, A., Campbell, D. and Thackway, S., 2016. Building research and evaluation capacity in population health: the NSW Health approach. Health Promotion Journal of Australia, 27(3), pp.264-267. https://doi.org/10.1071/he16045.

Harris, C., Allen, K., Ramsey, W., King, R. and Green, S., 2018. Sustainability in Health care by Allocating Resources Effectively (SHARE) 11: reporting outcomes of an evidence-driven approach to disinvestment in a local healthcare setting. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3172-0.

Hyde, B., Bowles, W. and Pawar, M., 2014. Challenges of recovery-oriented practice in inpatient mental health settings – the potential for social work leadership. Asia Pacific Journal of Social Work and Development, 24(1-2), pp.5-16. https://doi.org/10.1080/02185385.2014.885205

Jo Delaney, L., 2018. Patient-centred care as an approach to improving health care in Australia. Collegian, 25(1), pp.119-123. https://doi.org/10.1016/j.colegn.2017.02.005

Mulley, A., Trimble, C. and Elwyn, G., 2012. Stop the silent misdiagnosis: patients' preferences matter. BMJ, 345(nov07 6), pp. 65-72. https://doi.org/10.1136/bmj.e6572

Salins, N. and Jansen, W., 2011. Clinical audit on documentation of anticipatory "Not for Resuscitation" orders in a tertiary australian teaching hospital. Indian Journal of Palliative Care, 17(1), p.42. https://doi.org/10.4103/0973-1075.78448.