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New training for nurses: End of Life Law for Clinicians
By Patsy Yates AM, Executive Dean, Faculty of Health, Queensland University of Technology
Penny Neller, Project Coordinator, National Palliative Care Projects, Australian Centre for Health Law Research, Queensland University of Technology
Rachel Feney, Senior Research Assistant, End of Life Law for Clinicians, Australian Centre for Health Law Research, Queensland University of Technology
Ben White, Professor of End-of- Life Law and Regulation, Australian Centre for Health Law Research, Queensland University of Technology
Lindy Willmott, Professor of Law, Australian Centre for Health Law Research, Queensland University of Technology
Shi Ning Then, Associate Professor, on, Australian Centre for Health Law Research, Queensland University of Technology
Source: APNA Primary Times Summer 2021 (Volume 21, Issue 2)
Primary health care nurses have a significant and growing role in delivering end-of-life care1 in general practice, aged care, community health and other settings. Their clinical role at the end of life is multifaceted, and can include providing medical and personal care; recognising and responding to deterioration; involvement in clinical decisionmaking; and care coordination.
Decision-making about treatment and care for patients approaching the end of life is also a frequent, and often challenging part of primary-care practice, and involves nurses performing important legal roles. For example, many primary health care nurses develop close therapeutic relationships with the people they care for, providing them with a unique understanding of an individual’s end-of-life preferences and needs. This relationship means that primary care nurses are often an important source of information and planning for terminally ill individuals, and their families, support networks and substitute decision-makers.2
Nurses may identify the need for advance care planning, initiate planning conversations, and support people to make an Advance Care Directive and/or appoint a substitute decision-maker.2,3, They are involved in recognising or determining whether or not a person has capacity for medical treatment decisionmaking, and who is the decision-maker if the person does not have capacity.
Nurses have a significant role in managing pain and symptoms at the end of life.4,5 They may also advocate on behalf of individuals (and families) to the clinical team, for example, by promoting their participation in treatment decision-making, or recognising deterioration and communicating with the clinical team about the discontinuation of futile or non-beneficial treatment.5
Each of these examples involves applying (and following) end-of-life law, including the law relating to Advance Care Directives, medical treatment decision-making (including withholding or withdrawing treatment needed to keep the person alive), and provision of pain relief. Doing this successfully relies on nurses having sufficient knowledge and understanding of these laws. However, research shows that Australian health professionals, including nurses, have significant knowledge gaps about end-of-life law, particularly the law on providing pain and symptom relief, and substitute decision-making.6,7
"The ELLC training program has launched new nursing content exploring key legal principles related to nursing practice and end-of-life care."
The End of Life Law for Clinicians (ELLC)8 training program has been designed to help nurses in all health-care settings understand and feel more confident about the legal issues they face in end-of-life practice. This free national training program is funded by the Australian Department of Health and has been developed by the Queensland University of Technology. It comprises 11 online training modules on fundamental aspects of end-of-life law, and is complimented by End of Life Law in Australia9 , a website about the law in each state and territory.10
In August 2021, the ELLC launched modules with new nursing content, including tailored case studies and vignettes. The modules explore the legal issues that can arise in nursing practice, the role law plays in endof-life care, and key legal principles related to nursing practice.
The ELLC can help nurses to:
- better support others (individuals, their families, or colleagues) when legal issues arise
- confidently manage pain relief at the end of life
- prevent, manage and resolve conflict between patients, families and support networks or health professionals about treatment decisions.
Knowledge gained from this training can also help nurses manage legal risk and enhance their confidence in delivering lawful care.
We invite nurses and nursing students to undertake the ELLC online modules by registering at the End of Life Law for Clinicians training portal: https://palliativecareeducation.com.au/. Certificates of completion are available.
For further information, contact the ELLC team at firstname.lastname@example.org.
1. JJ Rhee, M Grant, H Senior et al., ‘Facilitators and barriers to general practitioner and general practice nurse participation in end-of-life care: systematic review’, BMJ Support Palliat Care, 2020, doi:10.1136/ bmjspcare-2019-002109.
2. T Water, K Ford, D Spence and S Rasmussen, ‘Patient advocacy by nurses: past, present and future’, Contemp Nurse, 52(6):696–709, doi: 10.1080/10376178.2016.1235981.
3. RB Arbour and DL Wiegand, ‘Self-described nursing roles experienced during care of dying patients and their families: a phenomenological study’, Intensive Crit Care Nurs, 2014, 30(4):211–218.
4. LS Ke, X Huang, M O’Connor and S Lee, ‘Nurses’ views regarding implementing advance care planning for older people: a systematic review and synthesis of qualitative studies’, J Clin Nurs, 2015, 24(15-16):2057–2073.
5. MJ Bloomer, R Endacott, K Ranse and MA Coombs, ‘Navigating communication with families during withdrawal of lifesustaining treatment in intensive care: a qualitative descriptive study in Australia and New Zealand’, J Clin Nurs, 2017, 26(5-6):690–697, doi:10.1111/ jocn.13585.
6. L Willmott, B White, P Yates et al., ‘Nurses’ knowledge of law at the end of life and implications for practice: a qualitative study’, Palliat Med, 2020, 34(4):524–532, doi:10.1177/0269216319897550.
7. BP White, L Willmott, R Feeney et al., ‘Limitations in health professionals’ knowledge of end of life law: A crosssectional survey’, BMJ Support Palliat Care, 2021, doi:10.1136/ bmjspcare-2021-003061.
8. BP White, L Willmott, P Yates, S-N Then and P Neller, End of Life Law for Clinicians, https:// palliativecareeducation.com.au, 2019, accessed 25 October 2021.
9. BP White, L Willmott and P Neller, End of Life Law in Australia: Australian Centre for Health Law Research, https://end-of-life. qut.edu.au/, 2019, accessed 25 October 2021.
10. BP White, L Willmott and P Neller, ‘Clarifying end of life law for doctors’, MJA Insight, 29 August 2016, accessed 7 October 2021. https://insightplus.mja. com.au