BNUR1900F24MAiD Presentation BB Edition PDF

BNUR1900 Nursing Fundamentals Concept of Family End-of-Life Care Medical Assistance in Dying Presented by Peter Kennedy RN, BScN, MBA November 21, 2024   During this module, students will:  Discuss the concept of family  Dev...

BNUR1900 Nursing Fundamentals Concept of Family End-of-Life Care Medical Assistance in Dying Presented by Peter Kennedy RN, BScN, MBA November 21, 2024   During this module, students will:  Discuss the concept of family  Develop an understanding of end-of-life care  Develop an understanding of Medical Assistance in Dying Learning Objectives  Develop insight into the impact of MAiD for the person and the family  Discuss the provision of care for the person who has requested MAiD  Discuss the provision of support to the family of the person who requested MAiD  Clinician 1.15 Incorporates knowledge about ethical, legal, and regulatory Entry to Practice implications of medical assistance Competencies in dying (MAiD) when providing nursing care. Plan   The purpose of family is to protect, teach, and nurture its members Family  The functions of family include means for survival, security, promotion of healthy emotional and social development, assistance with maintenance of relationships, instruction about society and world, and assistance in learning roles and behaviours  Family influences values, beliefs, customs, and specific patterns of interaction and communication  This includes health Potter & Perry, 2024  “A term used to refer to individuals who are related (biologically, emotionally, or legally) to and/or have Family close bonds (friendships, commitments, shared households and child rearing responsibilities, and romantic attachments) with the person receiving health care. A person’s family includes all those whom the person identifies as significant in his or her life (e.g., parents, caregivers, friends, substitute decision-makers, groups, communities, and populations).” RNAO, 2017, p. 72  Provides us with our initial perceptions of health and health promotion activities Family Helps us define health, establish beliefs and values about health, and provides guidance and guidelines for health and illness behaviours An effective family can integrate the need for stability with the need for growth and change A ‘healthy’ family has a flexible structure for the required tasks and is willing to accept help from outside the family system   A family unit may experience numerous changes and transitions throughout the life cycle Family and  Nurses play an important role in providing care to Nursing families  Therefore, we must develop skills to assess families  It is important that we consider people not only from an individual perspective, but as a member of a larger family structure  Recognizing structure of the family  Assessing function of the family  Understanding the current developmental stage of the family  Developing interviewing skills and communication skills  Families and  Familial relationships can be important for many persons as they age Older Persons  Older persons may become more dependent on family members to provide care and support Boscart et al., 2023  Aging and  Marriage or partnerships  Divorce Relationships  LGBTQ2 relationships  Changing relationships with adult children  Grandparenting  Siblings Boscart et al., 2023  Family  Spousal caregiving  Aging parents caring for adult children Caregiving  Adult children caring for aging parents  Grandparents raising grandchildren  Long-distance caregiving Boscart et al., 2023 Dying  “Death is not the problem; it is dying that takes the work.”  Dying impacts the person who is dying, their loved ones, and those caring for them  A challenging and private life experience  Death is rationalized differently for everyone Boscart et al., 2023   Should be available to all, in any setting, by the appropriate care provider  Many people prefer to die at home, though this varies across End-of-Life Care individuals  It is important that nurses are knowledgeable about the end-of- life care options and resources for the people they care for   “An approach that improves the quality of life of patients and their families facing the problems associated with life- Hospice threatening illness, through the prevention and relief of Palliative Care suffering by means of early identification and impeccable assessment and treatment of pain and other problems, (HPC) physical, psychosocial, and spiritual.” (WHO, 2020)  HPC comprises comfort care and may be the heart of caring  Often provided at home  Supportive comfort care Boscart et al., 2023   Palliative care is person- and family-centred care Guiding  Death, dying, grief, and bereavement are part of life Principles of  Caregivers are both providers and recipients of care the  Palliative care is integrated and holistic  Access to palliative care is equitable Framework  Palliative care recognizes and values the diversity of Canada on Palliative and its people Care in  Palliative care services are valued, understood, and adequately resourced Canada  Palliative care is high-quality and evidence-based  Palliative care improves quality of life  Palliative care is a shared responsibility Government of Canada, 2019   Nurses are exposed to dying and death across Death, Dying, healthcare settings and Nursing  Nurses will experience and process death differently  Grief is common, and developing effective coping skills is important  Debriefing and support from colleagues are essential  Medical  In 2016, Canada became one of a handful of countries to allow certain adults to request a Assistance in physician’s help in bringing about their own Dying (MAiD) death Overview  In 2021, a joint parliamentary committee reviewed Canada’s MAiD legislation after suggested changes  The goal in nursing is to support and provide care for the patient who has requested MAiD and to support their family MAiD  As defined in the Criminal Code, refers to when:  A Nurse Practitioner or physician provides assistance by administering a medication to a patient, at their request, that causes their death (i.e. practitioner-assisted MAiD) or  A Nurse Practitioner or physician prescribes or provides a medication to a patient, at their request, so that they may self-administer the medication, and in doing so, cause their own death (i.e. patient self-administered MAiD) CNO, 2021  MAiD Legislation Bill C-14 received royal assent, The GoC’s new Monitoring of Medical making it possible for eligible people Assistance in Dying regulations came to receive MAiD in Canada into affect (related to reporting) 17 June 2016 1 November 2018 9 May 2017 17 March 2021 Ontario government passed Bill C-7 passed which amends the legislation related to MAiD Crimincal Code to expand eligibility for MAiD Bill C-7 (CNO, 2021)   Bill C-7 (March 17, 2021)  The removal of the requirements for a person’s natural death MAiD to be reasonably foreseeable in order to be eligible to MAiD  The removal of the 10-day reflection period between the written request for MAiD and the procedure for those whose natural death is reasonably foreseeable  The removal of the requirement for consent at the time of the MAiD procedure for those whose natural death is reasonably foreseeable  Requiring only one instead of two independent witnesses to verify writing consent for MAiD, and that witness may now be a paid healthcare worker  The creation of new safeguards for those without a reasonably foreseeable natural death. There now must be 90 days between the first assessment and MAiD procedure, which may be shortened if an individual is at risk of losing capacity to consent CNA   RNs and RPNs can participate in MAiD by providing nursing care and supporting and NP or physician who is providing MAiD MAiD according to the law The Nursing  Nurses providing information must not coerce or encourage the person to choose MAiD Role  Nurses may perform activities such as (not limited to):  Educating patients, providing support and comfort to patients and families  Inserting an IV line (with an order) that will be used to administer medications that will cause the death of a patient  Acting as an independent witness CNO, 2021   The law does not compel an individual to provide or assist in providing MAiD Conscientious  Recognizes a nurse’s freedom of conscience Objection  Nurses may have beliefs and values that differ from those of a patient and may not be comfortable providing or participating in MAiD  Not conveyed directly to a patient  No moral judgements about MAiD should be shared with a patient or their family  The nurse must continue to provide care until replacement care provider is found CNO, 2021  Nursing Values and Ethical Responsibilities CNA Code of Ethics D. Honouring Dignity: Nurses recognize and respect the intrinsic worth of each patient 12. Nurses understand the law so as to consider how they will respond to medical assistance in dying and their particular beliefs and values about such assistance. If they believe they would conscientiously object to being involved with persons receiving care who have requested assistance, they discuss this with their supervisors in advance. CNA, 2017 CNO Webinar https://www.youtube.com/watch?v=mrNH-dvkcnQ  Reflect As a future healthcare provider, Consider how you would respond How might you manage your own how might you feel if you are if someone asked you about how emotions or thoughts about it in assigned to care for a patient who to request MAiD. What would order to respond in a caring and has requested MAiD? your initial response be? supportive manner?   David has deteriorated rapidly with his Alzheimer’s Disease. He is still cognizant most of the time and is able to make his own health care decisions, at this time. He remembers how devastating this disease was for his uncle, and he is adamant that he does not suffer the same outcome. He has started talking to his family about his final wishes, including a do not resuscitate (DNR) order. He has also briefly mentioned the idea of MAID, however, he isn’t ready to have a full Perpetual conversation with his family about this yet. David brings it up to you, unexpectedly, in a visit to the Case Study doctor’s clinic.  Sandra is noticing the decline of David and is very emotional about the anticipated outcome. David has started relying heavily on a previous co-worker for support. This co-worker recently lost their spouse from Alzheimer’s. Sandra is feeling very upset that David isn’t relying on her and their children, and instead, is relying on a ‘stranger to the family’.  Answer the following questions based on the information you have about the family, and your knowledge from today, and previous classes. 1. Develop a response to David’s unexpected Perpetual question about MAID. Case Study 2. David goes on to ask about eligibility and process for MAID. Develop a response to this question. 3. Offer support to Sandra in regard to feeling ‘left out’; include in your response what the concept of family can mean to different people.   Now that you have learned about MAiD, what are your thoughts about this particular aspect Reflection of end-of-life care?  How would you feel if a family member of yours requested MAiD?  How would you feel if one of your patients would request MAiD?  Would this create interpersonal conflict?  How would you approach this conflict?