Introduction
The advance care planning is a route paper where the elder people establish an action plan at the moment when they do not have the capacity to take a decision by themselves or their life is in danger, and they are physically unable to decide. The advanced care planning in not only a medical and nursing issue, but a legal issue where the elder gives the instructions of his life at the moment when they cannot make decisions.
The testament is the last part of the advance care planning, but previous to that, there are medical procedures and instructions to follow in certain conditions of the person. First of all, the person must think, with the advisory of his doctor, what are the treatments and procedures necessary for him in a hazardous and dangerous situation . The most typical are:
Cardiopulmonary resuscitation: The procedure is very popular to reanimate a person who is near death. The stimulation of the heart and lungs to promote the blood movement and to bread of the patient is necessary in most case to revive a person.
Ventilator use: The failure in lungs could be improved by the use of ventilator machines connected to windpipes that introduce clean air to the lungs. The lung is one of the organs that mostly fail in people with advanced age.
Artificial Nutrition: The use of intravenous feeding tubes is used for people that are unable to eat or drink. Another way to feed the patient is introducing the tube from the mouth through the trachea until the stomach.
Comfort care: The comfort care is a very important provision in the advance care planning. A comfortable environment for the patient, with convenient medication and emotional counseling, the health professionals help the patient to improve his quality life while he is in treatment .
An advance care planning for the community is a necessary approach, due to the continuous increase in the rate of elder population in the country. The elder people are an important population group that requires special attention, and a universal advance care planning for the community is more a necessity than a luxury.
Objectives
1. Develop an advance care planning for the people of the community from their retirement age until its death
2. Develop an education plan for the people of the community related to the proposed advance care plan
3. Increase the awareness and availability of resources for the proposed advance care plan.
Literature Review
Advance Directive Wallet Card. The National Institute of Aging reveals an Advance Directive Wallet Card, which has four parts: Advance Directive, Help copies, Held other copies and Healthcare agent. The Advance Directive has an ID format which the person may take in his wallet or purse to help them in the case there is an emergency. The Office of the Attorney General of Maryland developed the format .
Australian Advance Care Plan: The Australian Health Ministry by its Advance Care Plan program (Advance Care Planning Australia, 2016) proposes an eight-step plan for the Advance Care which is:
A. Past health experiences: The user must record all the previous health experiences to develop his personal Advance Care Plan. The past health experience must consider the diseases and conditions that are not present time.
b. Current and future health: The person must know what exactly his current condition is and what the projections for the future are.
c. Plan the care: The person must write a plan for the care needs and resources.
d. Choose a substitute: It is important to name a person, preferably younger, to represent the person.
e. White its will: It may be a testament, but it a general definition of all the actions necessary to achieve.
f. Inform other the decision: The family and close friends is the first people that must receive the decision of the person .
g. Review the plan: Every month and year; it is necessary to review the original plan and make adjustments to the plan.
h. Help to a family member or a friend to develop his Advance Care Plan.
Values statements and treatment: The values statements and treatment are studied in two different universities and how they influence in the Advance Care Planning of those institutions. The study consisted of two tests evaluating the quality of the health care system and how it helps in the advance care planning .
Methodology
The first methodology consists in a field study with people in retirement age, higher than 65 years old. 100 to 150 of a specific county in the state. The study will get what are the most important conditions and diseases of the studied people and how much money and assets the person has to affront its condition. The study field will be developed in a timeframe of 3 years.
With the three most important diseases and conditions, the information will be given to a medical doctor that will determine the common symptoms and potential complications of those diseases and conditions.
The symptoms and potential complications will determine the necessary procedures for the people to survive and improve his quality life. The improvement of those physical complications increases the living possibilities of the patients.
The study closes with a legal advisory related to the recommended configuration in the Testament, the will documents of the people and how the Advance Care Plan could be enforced by local law to apply them to all the citizens with a retired condition.
The second methodology is to communicate the results in the development of the Advanced Care Plan to the population of the city and to promote the creation of Advanced Care Plans for all the habitants of the city with retirement age.
Formative Evaluation:
The formative evaluation is the evaluation of the proposed project previous to the implementation. The most important moment to evaluate the project is in the methodology execution. The selection of the sample to get the field data is the most important part of the formative evaluation. After the sample selection, the other part of the formative evaluation is the communication schedule of the Advance Care Plan; the schedule must be adapted to the human resources availability for the communication execution.
Summative Evaluation:
The summative evaluation is made after the project execution. The most important indicator in the summative evaluation is the percentage of people that created his new Advance Care Plan. The evaluation will take as reference the studied sample.
Timeline
The execution of the project is divided into the following tasks:
■ Sample definition: 3 days
■ Field Study: 7 days
■ Data analysis: 1 day
■ Medical doctor interview: 1 day
■ Law Professional interview: 1 day
■ Development of Advance Care Plan: 7 days
■ Implementation and Diffusion of Advance Care Plan in the county: 14 days
■ Revision and adjustments: 1 day.
The total time of the project is 35 days. The timeline considers serial activities due to the limitations of personnel to develop the study and Advance Care Plan execution.
Reference List
Advance Care Planning Australia. (2016). Create a Care Plan. Retrieved from http://advancecareplanning.org.au/advance-care-planning/create-a-care-plan/
Emanuel, L. (2000). Advance Care Planning. Retrieved from http://triggered.clockss.org/ServeContent?url=http://archfami.ama-assn.org%2Fcgi%2Fcontent%2Ffull%2F9%2F10%2F1181
Gillick, M. R. (2006). Advance Care Planning. Retrieved from N ENGL J MED: http://services.medicine.uab.edu/publicdocuments/palliativecare/Advance%20Care%20Planning.pdf
Health Victoria. (2016). Advance care planning. Retrieved from https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/end-of-life-care/advance-care-planning
Kolarik, R. (2002). A comparison of values statements and treatments preferences. Retrieved from https://www.researchgate.net/profile/Gary_Fischer/publication/263256292_Advance_Care_Planning_A_Comparison_of_Values_Statements_and_Treatment_Preferences/links/54b3e4150cf26833efcfdd4f.pdf
National Institute of Aging. (2015). Advance Care Planning. Retrieved from https://www.nia.nih.gov/health/publication/advance-care-planning#what
