ACP should be part of the routine practice for every resident soon after admission to residential aged care. Many residential aged care facilities will have specific policies in place. They also may have forms and documents they use in their facility to document the resident’s wishes. They are also likely to have defined processes for storing these documents for future use.
Nurses' Role
- Nurses should be familiar with their facility's policies and procedures for ACP.
- Nurse should know where ACP information is recorded and how to access it.
- Nurses should ensure that asking about ACP is routinely done on admission and checked whenever care plans are reviewed.
- Nurses will often lead ACP discussions in residential aged care to make sure there is clarity about a resident’s wishes for future care.
- Discussing ACP may take several meetings as the resident may want to think about the questions.
- Nurses should check if the resident would like someone from their family or friends to join them during these discussions.
- Nurses may also wish to invite the GP to participate in the ACP process and seek permission to make a copy available to the GP.
- Decisions about end-of-life care options need to be revisited regularly, regardless of choices made previously.
- Nurses can also check if ACP needs to be revisited if the resident’s health or circumstances change.
Remember, for resident’s with cognitive impairment, it is important to understand if they have the cognitive capacity to make decisions about their future care. Competence and capacity should be considered.
Helpful Resources
Page updated 18 December 2024