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Initiating difficult conversations with the elderly or very ill about their end-of-life care is very much the ‘bread and butter’ of patient-centred nursing care. April 16 has been designated Conversations that Count Day as a national awareness day for advance care planning (ACP). Find out more ePostcards and eLearning in this sensitive but sensible area.

Most of us want to die peacefully in our sleep at an advanced age. Many of us may end up dying attached to tubes in a hospital.

Advanced Care Planning, promoted in New Zealand since 2010 by the National Advance Care Planning Cooperative, aims to prepare patients and families to make informed choices and plans about their future health care – especially end-of-life care.

To help families and patients take the first steps to discuss what matters most to Aunt Joan or Poppa in the last months of life, the cooperative this year promoted Conversations that Count on April 16.

Along with events and talks by nurses, GPs, and others involved in ACP, people were encouraged to send postcards – both electronic and real – to start a conversation with their family and friends on the topic, be it at round a family meal; a walk on the beach, a game of golf or fishing off the jetty (the postcards posters and helpful advice on promoting conversations can be found at www.conversationsthatcount.org.nz)

The cooperative, which now has 800 members nationwide, also offers training of GPs, nurses and other health professionals in ACP. The South Island Alliance of district health boards is promoting ACP throughout the south through its Health of Older People Service Level Alliance (HOPSLA).

Late last year, nurse Jane Goodwin was appointed to the newly established role of ACP facilitator for Canterbury, but she has had a long-standing passion for the concept since researching her Master’s thesis in 2006. She has also been involved in the delivery of the ACP Cooperative’s training since 2013, which has taken her across New Zealand teaching the Level 2 ACP programme to health care professionals.

ACP training helps sharpen skills

Goodwin says any health professional can have an ACP conversation and many have been doing so successfully for years. While there are no required competencies, the ACP cooperative does want nurses and other health care workers to ensure they are comfortable with the process – and aware of the challenges discussing ACP may pose – before initiating such conversations with patients and their families.

The cooperative has developed two levels of training to help nurses do just that – the first level is offered online via four interactive eLearning modules, which guide professionals through understanding the full ACP process, including the legal basis, how to explain the benefits of ACP, and when to refer a patient on to someone with level two skills. About 340 health care workers have completed the level one training programme since it went online in August last year.

The second level course is delivered via a two-and-a-half-day, face-to-face course and trains people to be ACP practitioners who can initiate, facilitate, and participate in ACP conversations including assisting patients in the documentation of their ACP decisions. The 56th level two course got underway in April, bringing the number of level two trained staff up to about 550 plus.

Goodwin says the ACP fits very well within the nursing scope of practice, as it is a process of conversations between patients, their families and their health professionals. “This is very much the bread and butter of nursing – patient-centred care.”

She says the process is also not so much about completing a document – though some patients may wish to do so with a written advanced care plan – but about exploring what is important to the patient.

“It may be that a nurse plants the ‘ACP seed’ with a patient when they are on the ward asking questions like ‘what is important to you about how we care for you’ or ‘have you talked to your family about what worries you about your condition?’ etc.” says Goodwin.

“These conversations can then be continued by their general practice or their specialist or their community team on discharge.”

She says in Canterbury a number of specialist nurses, working in areas like heart failure or motor neuron disease, have picked up and run with ACP and are completing the whole process with patients from inception to completion.

“They have a strong relationship with their patients and are able to identify what the likely issues are for the patients as the diseases progress.

“We are finding other nurses in general practice and the aged residential care sector are very happy to help facilitate the first parts of the ACP process – like exploring a patient’s beliefs and values – but will refer them to their GP to complete the advanced directive portion of the document.”

To find out more about Advanced Care Planning go to:

www.advancecareplanning.org.nz