Legal Aspects

Question 1

Domain 1 of MRPBA

Answer 1

See something, say something
Assess deteriorating patients
Deliver patient/client care
Identifying urgent and unexpected findings
Taking appropriate and timely action
Potential range of reactions to medicines
Actively monitor the effects of medication and manage adverse reactions

Question 2

Domain 3 of MRPBA

Answer 2

Make appropriate adjustments to communication style to suit patient need
Active listening and appropriate language and detail: verbal and non-verbal clues

Question 3

Active listening components

Answer 3

Paraphrasing
Clarifying
Reflecting
Summarising

Question 4

Legal Aspects of care

Answer 4

Consent
Palliative treatment
Assisted dying
Advance care directing and enduring Power of Attorney

Question 5

How is consent valid

Answer 5

1. The patient has the capacity to make a decision about the specific issue
2. the consent is given voluntarily, free from manipulation or coersion
3. the discussion between the patient and healthcare practitioner is transparent and involves two way communication
4. the patient is able to clearly understand the information (it is provided in a manner the patient can understand)
5. The information provided and the consent given relate to the specific health care provided
6. The patient has sufficient to consider and clarify information

Question 6

What is implied consent?

Answer 6

Patient indicates their agreement through their actions or by complying with the health care practitioners instructions

Question 7

Explicit/express consent

Answer 7

Person clearly states their agreement to healthcare

May be verbal or in writing

Question 8

Can consent be withdrawn?

Answer 8

Any patient who has capacity to consent may also decline any or all health care at any time, even when this is contrary to medical recommendations and in circumstances may result in the death of the patient.

Question 9

Patient considerations for when consent is withdrawn

Answer 9

Confirm the patient has capacity to make the decision

Check the patient’s understanding and looking for any health literacy or communication issues

Exploring the reasons for the decisions including:
- a refusal or an inability to sign the form
- any cultural or religious conflict that the patient may have

Exploring other health care options that might be acceptable to them

Question 10

Define informed consent

Answer 10

A persons decision, given voluntarily, to agree to a healthcare treatment, procedure or other intervention that is made

Decision is made with adequate knowledge and understanding of the benefits and material risks of the proposed intervention

Question 11

Advance care directive

Answer 11

If a person loses the capacity to make the decision → ACD provides instruction that a person has made about future medical treatment/healthcare

Only applies if a person loses capacity
Signed and dated by a health professional who is not witness to the person

If there is an AHD and later an EPOA makes a decision → the AHD will prevail

If there is any uncertainty of the direction → must first consult the substituted decision make - if there is one

Question 12

Enduring power of attorney

Answer 12

legal document

Outline who you would like to manage your medical affairs when you no longer have capacity

If an EPOA is appointed, and another is appointed down the line → the earlier POA will be revoked

Direction is inconsistent with good medical practice

Circumstances changed

Question 13

Powers of attorney requirements

Answer 13

• Power over 18 years have capacity
  
  • In writing
  • Signed by person/person instructed on behalf of person and not a witness or persons enduring power of attorney
  • Witnessed
  • Signed and dated by a health professional who is not witness or not connected to the person

Question 14

Ryan’s Rule

Answer 14

3 step process to support patients of any age, their families and carers to raise concerns if a patients health condition is getting worse or not improving as well as expected

Question 15

How to evoke ryan’s rule

Answer 15

• Call nurse
  
  • Call doctor
  • Evoke Ryan’s rule

Question 16

Gil lick competent

Answer 16

applies to younger people consent issues
Assessment performed by an eligible health practitioner

Question 17

Euthenasia

Answer 17

deliberate and intentional act of one person to end the life of another to relieve their suffering
Voluntary (At the request)
Non-voluntary (not competent)
Involuntary (without request)

Question 18

Paraphrasing

Answer 18

Restate the same information, using different words to more concisely reflect what speaker said

Allows speaker to hear and focus on his or her own thoughts
Allows speaker to see that you are trying to understand the message

Question 19

Clarifying

Answer 19

Invite the speaker to explain some aspect of what she or he said

Gives the speaker the opportunity to elaborate and clarify what was said.
Gives opportunity to identify anything that is unclear

Question 20

Reflecting

Answer 20

Relaying what was said back to the speaker to show that you understand how he or she feels about something

Deepens understanding of feelings and content
Allows the speaker to see that you are trying to understand his/her message and perceptions

Question 21

Summarising

Answer 21

Identify, connect, and integrate key ideas and feelings in what the speaker said

Helps both listener and speaker identify what was most important to the speaer

Question 22

Active listening - do’s

Answer 22

Listen more than talking

Let the speaker finish before responding

Ask open ended questions

Remain attentive

Be aware of own biases

Manage own emotions

Be attentive to ideas and problem solving opportunities

Give verbal and nonverbal messages that you are listening

Listen for both feelings and content

Question 23

Active listening- dont’s

Answer 23

Dominate the conversation

Interrupt

Jump to conclusions

Finish the speakers sentence

Respond with blaming or accusatory language

Become argumentative

Demonstrate impatience or multitask

Mentally compose your responses about what to say next

Listen with biases or shut out new ideas

Question 24

Double Doctrine Effect

Answer 24

only apply when the patient is near death, most critical
element is intention. As long as intention was to relieve the pain and symptoms and
not cause death (although no Court Case in Australia to confirm doctrine – applied in UK, US, Canada and NZ – similar legal systems. In QLD legislation has been introduced to cover version of the double effect.

Question 25

VAD considerations

Answer 25

Initial discussion Capacity to make decision Coercion Discussing ineligibility

Question 26

Initial discussion - VAD

Answer 26

What are patients’s concerns Impact on QOL Options in solving concerns Does the patient meet the requirements Patient needs to make formal request to doctor

Question 27

Capacity to make decisions - VAD

Answer 27

Does the patient understand Does the patient retain information Can the patient use the information Can they communicate their decision (not necessarily verbally)

Question 28

Coercion - VAD

Answer 28

VAD decision must be volunatry Can involve discussions with family and friends but cannot be coerced by their decision

Question 29

Discussing ineligibility - VAD

Answer 29

Only available for people dying within 6 months Does not allow people to die whenever they want but gives the patient an option if they meet legal criteria Patient can access 2nd opinion Provide patients with other options to improve QOL

Question 30

When can health professionals be non-compliant to AHD

Answer 30

Direction is inconsistent with good medical practice Uncertainty of the direction Circumstances changes - i.e. advances in medical science

Question 31

What are the principles of VAD in QLD

Answer 31

Value of Human Life Dignity - Every person has inherent dignity and should be treated equally and with compassion and respect Autonomy High Quality Care and Treatment Accessibility Informed Decision Making Protecting those who are vulnerable Respect for diversity

Question 32

How can a VAD substance be legally administered in QLD

Answer 32

Self administration - Default method of administration Practitioner administration - May be followed through if coordinating practitioner deems self administration is inappropriate

Question 33

What is the role of the coordinating practitioner in the VAD process

Answer 33

Coordinates VAD process and acts as primary clinical contact Receives the first, second and final requests from the patient Performs the initial eligibility assessment and the final review Prescribes the VAD substance

Question 34

Explain the term Voluntary Starvation

Answer 34

Every competent adult has the right to refuse to eat and drink, and not to be force fed contrary to their wishes. If a person dies as a result of this → patient will not have committed suicides Person would have not committed suicide but would have exercised their right to refuse food or drink

Question 35

Eligibility for VAD In QLD

Answer 35

Must be diagnosed with condition that - Is advanced and will cause death - Is expected to cause death within 12 months - Is causing intolerable suffering Have decision making capacity in relation to VAD Be acting voluntarily without coercion Be at least 18 years old Australian citizen or permanent resident

Question 36

What is the process for VAD in QLD

Answer 36

Phase 1: Request and Assessment - First Request (not considered --> person seeking additional information, person making request to a non medical practitioner) - First assessment (performed by coordinating practitioner) - Subsequent Consultation (performed by external practitioner --> now consulting practitioner) - Second Request (written request) - Final Request (cannot occur until 9 days have ended since the first request) - Final Review (coordinating practitioner states patient has decision making capacity) Phase 2: Administration of VAD substance - Administration Decision - Appointing the contact person (anyone over 18; must inform coordinating practitioner once patient dies) - Prescription of VAD substance - Supply of VAD substance - Administration and Patient Death (self administration or practitioner administration) Phase 3: After patient death - Disposal of substance - Death notification (must complete death certificate)

Question 37

VAD

Answer 37

more commonly used in Australia to refer to the assistance provided to a person by a health practitioner to end their life. ‘Voluntary’ indicates that the practice is a voluntary choice of the person, and that they are competent (have capacity) to decide to access VAD.