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Just wondering if we can view how our marks were allocated for assessment 2?

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Hi, just wondering if we need to reference the ACD? or just the CPG?

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are quotes included or excluded in the word count of the essay?

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Hi Paula, would it be appropriate to talk about the omission of fluids/ hydration in the case study? The CPG End of Life Care notes the importance of fluids and EBP shows hydration can maintain dignity during terminal palliative care.
Thanks

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Hi when Tyler had wheezing that can cause him aspiration and lead to hypersalivation due to respiratory tract infection as he had dysphasia.  From Friday- Sunday morning it’s has been mention that mouth care was done but there was no proper documentation eg from what mouth was cleaned with
Was it dry, any solution used?
But for his hypersalivation  medication was given
I wanted to mention this all and personal hygine as well
M I correct

Thankyou so much for your help

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Hello,
In assessing how Tyler's pain was assessed i cannot see a reference to specific pain scales being used to document pain. Do we assume that no pain scale was used?

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Hi,
Just wondering whether both the NPCS standards and NMBA or NSQHSS standards need to be used in every episode of care we critique? Or can we use the NPCS standards for some episodes of care and then the NMBA in other episodes of care.
Thanks

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Hi,

I am just curious, i have found research stating that an ACD is only valid if the patient does not have the mental or verbal capacity to make decisions then future care decisions can be referred to the ACD. However when talking about how it is stated in the ACD that he would like all his family members to be present can we use this as we can assume from the case study he still has the verbal and mental capacity? or can we only use the fact he verbally asked the nurse for this. thanks!

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Hi,
i know that it has already been addressed that Tylers ACD was not applicable due to his cognitive state, so therefore my question is was the nurse not in the wrong for identifying that Tyler was extremely SOB on the Thursday morning so she applied the CPAP to assist with breathing despite in his ACD he said he did not want it on during the day?
Or could we assume that he also may have voiced this preference but it was not documented therefore the nurse did not know? because he later that afternoon requested it to be taken off.

Thanks in advance

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Hello,

I think someone's already asked this but I can't find the post anymore.
Why was Tyler suddenly using a CPAP machine on Thursday afternoon instead of his NIV? Do I assume that they're the same thing? as NIV was applied during the morning on the same day.

Thank you

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When critiquing care are we required to provide recommendations of what should have been done to demonstrate good palliative care? Or is it more just about identifying and explaining how the care was inappropriate and not really providing a step and step account of what the nurse should have done. Thanks so much for answering my question :)

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What is the reference Brown et al. (2017) in the case study green book (Aetiology of MND page)? It's not listed in the references.

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Hi there,

I have two questions regarding this assessment.

1) Could you please elaborate with any suggestions of how to demonstrate our understanding of the MND disease trajectory? Is it just through comments relating to Tyler's condition in the episodes of care or are we expected to speak about MND in more detail somewhere in our criticisms?

2) In our critique, are we expected to offer solutions to assist the areas requiring improvement or are we only expected to speak about the areas for improvement? Eg. should we say "in future practice, this could be implemented to improve this outcome and provide care in line with the standards".

Thank you!

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Hi!

Could I please clarify if the fever Tyler experiences is classified as "acute" deterioration because of it's sudden onset or is it more expected given his history of infections? Is this fever, given it goes quite high, considered severe enough to be classified as acute deterioration?

Thank you!

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Hello there,
For this assignment task, would formatting our paragraphs in a way of combining goals be suitable? For example (for the care of the dying pt CPG), paragraph one is goal 1,2 and 3 and so forth and we talk about how these are met/missed whilst tying them into the other standards? Or am I missing the point?

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Do we need to define MND ALS? and palliative care? or is this a waste of word count and it is assumed we know what it is.

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Regarding in text reference to case study and ACD

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Regarding in text reference to case study and ACD

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Hi, I apologise if this question has been asked before but I didn’t find answer about in-text reference for case study and ACD Because they both in cite like (ACU, 2021) do we need to specific with (ACU, 2021a) and (ACU, 2021b).
I really appreciate. Thanks

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Hi Paula, I wanted to ask about the timeline for his illness progression - by 'unstable' does the MO mean this was the start of the terminal phase? Or, as outlined in the end of life care CPG, did the terminal phase begin once he had a change in functional status and not tolerating oral fluids/food 6 months ago?

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do we need to have sole, individual paragraphs about positive episodes of care or can we just mesh positive aspects of care into all the paragraphs which talk about a negative episode of care. e.g when talking about how a proper pain assessment tool was not utilised, mentioning how however, analgesic was administered which did provide pain relief.

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About using the standards to support ommission of care do we use substandards from only one standard or mixed standards are ok?
for example
if i say documentation was not done properly . Do you expect us to use assessment of need substandard (pallilative care standard), 1.2, 1.3 or is it ok to use 1.1 and then jump to other standards to support our critique.

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In regarding to lack of using assessment tool, would it be appropriate to just discuss how Tyler asked for more pain relief but no assessment done as mentions assmessment tool maintained in caring for dying patient cpg, or disscuss all relevant distress symptoms such ad pain, breathlessness, restlessness.

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Hello,

I wanted to clarify the use of the NSQHCS and NMBA standards, I know it says we can only critique using only ONE of the CPG's but does this also apply to the standards or are we allowed to use both the NSQHCS and NMBA standards as well as the NPCS in our critique?
Probably a silly question but I didn't want to end up only using one of the standards if we can use both!
Thank you!

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I was hoping to get some clarification and feedback on the general rundown of my essay to see if it flows through and makes sense?

My CPG that I will be doing is end of life care and my issues that I will be focusing on will include:
1. Fluid intake/dehydration as it is an important potentially reversible cause for dehydration in end of life care
2. Infection (as they stated it went down), however did not completely go away, which could have potentially taken a turn on his health (he also did want all infections to be treated)
3. his wishes for being visited by a priest/minister in his ACD did not occur, even though he requested to be seen by one at the end of his life
4. A family meeting with all members of the family(even the ones with tension) did not end up occurring from my assumption
5. and potentially talking about how vital signs were not escalated in the end, as his last set of obs did rapidly deteriorate with his RR at 5, (not sure though if the obs discontinued due to making the patient feel more comfortable)?

Thank you in advance :)

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Hi there,

I noticed that in the information about the assessment in the case study book it mentions that marks and feedback for this assessment will be provided via Turnitin, does this mean we will receive the marks for this assessment 3 weeks after the due date or will we have to wait until December to have an idea as to whether or not we've passed the assessment and consequentially the unit?

Thank you!

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Hi!

Are we allowed to make a criticism on a lack of care over the whole time period? For example, I would like to criticise the poor documentation demonstrated throughout Tyler's care, can I criticise it as occurring multiple time throughout his care or do I have to specify one specific episode of care when I criticise?

Thank you!

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Hi there, I know this question was asked before, but I can't find it uploaded anymore. Since Tyler is able to communicate with the staff up until the end, does that make his ACD not applicable? The NSW ACD document says it's for people who can't communicate or make decisions for themselves. I already have quite a bit in my essay surrounding his ACD.. can I leave it in there? Thankyou kindly in advance

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Hi there,

The 'National Consensus Statement: essential elements for safe and high-quality end-of-life care' created to be used in tangent with the NSQHSS standards (and mentioned throughout the end-of-life standards) was published in 2015, is this still an appropriate contemporary reference to use even though its 6 years old?

Thanks!

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Hello!

I'm trying to find the references from week 1, specifically WHO, 2021 and PCA, 2021. This is regarding the principles of palliative care. These websites have not been put in the reference list. Could you please provide them?

Thank you

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Hello, I just wanted to ensure that these are appropriate parts of the care to critique as I am quite worried after last assessment's results. I'm using the end of life cpg to critique. 1. Issues around the infection not being picked up/actioned quickly enough/lack of thorough assessment in response to his increasing temp until 1900 2. The lack of timely identification that he was at risk of deteriorating/dying on Wednesday & Thursday as evidenced by his increasing SOB/wheeze/declining respiratory function which are common clinical indicators that death may be imminent in ALS. 3. The lack of reassessment and communication with Tyler/his family around goals of care despite him having deteriorated to the point where he was requiring repositioning (in his ACD he stated he would find life unbearable at this point and wish to stop treatment). 4. The lack of holistic assessment of his psychological, social, spiritual needs throughout the case study. Thank you so much.

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Hi Paula,
I'm just trying to work out how to structure my assessment. If I were to choose the Care of Dying patient CPG, would it be wise to discuss each section of the CPG (e.g. pain, agitation, N+V etc..) and critique how well or poorly the RN met these guidelines using NMBA/NPCS/NHSQDD and literature to support each section? So there would be like 11 elements of care to address. Or, perhaps it would be better to choose just a few from reviewing the case study? Not sure if we would be penalised for not addressing every aspect of the CPG.

Thanks a lot! Hope that makes sense.

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Is it ok to critiquing Tyler's history since symptoms began (eg 18th months ago, 12, 6 months ago) in the case study. I am using End of Life Care CPG and have done some reading on benefits of early palliative care planning. Or are you expecting us only to cover care from "collect cues" in the case study?

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I would like clarification that I am referencing the guideline used correctly.
Author is Australian Catholic University?
Date will be "n.d." as no date written on the document?
Heather

Edit: Also when referencing multiple standards throughout the assessment do we need to put the standard in the reference list or leave blank as we are citing multiple standards throughout?

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Hello, Tyler signed his AHCD in 2019 however, his "diagnosis" was 18 months ago, when are we to assume the time is currently?
Are we assuming he signed that when he was diagnosed?

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I am just wondering. how many references do we need for this assignment??

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Tyler requested for more analgesia for his increased pain and discomfort. However, it wasn't stated that the nurse administered pain relief, is this an inferred assumption?

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Hi there!

Just wanting to get some confirmation as to if my structuring is along the right lines!
I'm wanting to write 4 or so paragraphs talking about each episode of care I will critique and in each of those paragraphs I'll discuss the issue, how the NPCS are applied and then how the other standards are applied. Is this an appropriate approach to the structuring?

Just want to make sure I understand properly!

Thank you!

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Hi!

I am after come clarification/guidence on whether the structure should be focused around an event or around a type of care such as Family and Patient Support. Can we lose marks on choosing the wrong one or is it entirely up to us how we structure the information?

Thanks!

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Hi there!

Just wanting to clarify if it appropriate for us to use the Care of the Dying Patient CPG at any point in Tyler's care considering the document specifies that the Symptom Observation Chart should be implemented once a Care of the Dying Patient Plan form has been completed and vital signs have ceased.
Is it still appropriate to criticise care, such as the improper escalation of care regarding Tyler's fever on the 19th of March 10 days before Tyler's death, using this CPG or would this CPG only be applicable once Tyler reaches the Terminal phase and is actively in the process of dying?

I ask this because the EOL CPG does not discuss symptom management in much detail and I believe it won't be as applicable for my criticisms.

Thank you!

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Hi there, apologies if this question has already been asked
I would just like to clarify under "consider the patient situation" the last paragraph under 6 months ago about the mother and son visiting it states "When his family visit, Catherine generally takes the girls and leaves Tyler at home. Although this an ideal situation, Tyler has come to accept the conflict between Catherine and Joyce. "
Is this meant to be ideal or unideal? From what I interpret from the situation Tyler would want his family together not being seperated when they visit but I'm not sure
Thanks
Chloe Vandermaat
S00194600

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For End of Life Care CPG, should we discuss the terminal phase and unstable phase as both are considered 'deteriorating' ?
Many thanks

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apologies if this has been asked before, but are acronyms for phrases like Clinical Practice Guideline (CPG), End of Life Care (EOLC), Advanced Care Directive (ACD), Multidisciplinary team (MDT) and Motor Neuron Disease (MND) allowed throughout the case study? thanks in advance

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do you consider not providing analgesia and not conducting any assessment are two different espisode of care ?

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Hi, just wondering when referencing leo, my leo page displays NRSG374 P of Nurs Palliat Approach 2021 Semester 2 National. Is this correct to reference as its displayed or would you prefer - NRSG374 Principles of Nursing Palliate Approach 2021 Semester 2 National.

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Hi,
Just wondering if I would be marked down if all my critiques were based on a certain day. Most of the omissions of care which I would like to critique are from Thursday March 25th.
Thankyou

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Hi,
I understand we are to chose either the NMBA or NSQHS standards for practice to support our critique however are we to utilise the standard as a whole (Standards 1-7) and be specific (e.g. refer to NMBA standards 2.2 and 6.1 etc) or are we to chose a specific sub-standard and focus on that (e.g. NMBA Standard 2: Engage in therapeutic and professional relationships) and then utilise all points (2.1 - 2.9).

I hope this question make sense.

Thanks :)

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Hi
I was a bit confused
Was Tyler provided with personal hygiene like bathing/ showering, applying lotion, including bed- baths

I can see only mouth care was done

Coz I cannot see anywhere
Can I critique based on this???????

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Hello,
In caring for dying patient cpg, it mentions pain assessment tools should be maintained but it does not detail what kind of tools, do we just using evidence based articles to expand it such as pointing out other assessment tools should be used.
can we assume that there was no evidence the RN utilise the SOC and other formal documentations?

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Hi!

Should we spend some time discussing the contents of the CPG we'll be using to critique or is it expected that the person reading will already be fully understanding of the CPG's?

Thanks

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I am having trouble figuring out how to reference the ACU sources.

For example,  the CPG: Care of a dying patient. Would it be (ACU, 2021) ?

But would the case study have the same in text reference? How do we make them differ?

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Apologies if this has been addressed already. Is it requred we have a title page, as we usually put our word count in it there. If not where would you like the word count, in the header or footer?
Cheers

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Hi,
I know the case study needs to be referenced. However, does it need to cited in the essay all the time? I feel like it adds up my word counts. Can we just mention "as per the case study....." without citing it?
Thanks.

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Hi Paula, I notice Tyler's ACD is dated 18/9/19, and was completed 6 months before he died. Now there are dates in the green book for week he died (ie died on 17 September) this doesn't add up. I'm guessing this was not an intentional error.

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For caring for dying patient CPG, is it correct to analise the care only from Wednesday to Sunday? and is it acceptable to discuss what evidence base care should be according to the cpg and from other litteratures, for example the RN should have considered prn analgesia to help with dyspnea, then analise the chosen care based on information above, and why NMBA, NPC standards were not maintained.

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Hi Paula,

I've read that for ALS it is common for death to occur due to a respiratory tract infection. It is noted within the case study that Tyler developed a wheeze, however this was never investigated. Do you this it's appropriate to say that Tyler may have deteriorated due to a respiratory tract infection and that this was a reversible cause of death that could have been investigated and possibly treated?

Thanks for your help!

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Hi!

Just wondering if we can assume the reader is already well rounded on the contents of the case study or if you'd suggest that we give a general overview of what happened in the case study as a part of the essay before delving into the criticism?

Thank you!

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Hey Paula,

Can we assume that Tyler was not offered to be visited by a priest/minister before he passed?

Thank you!

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There's no date on the guideline, do we reference as n.d or as 2021? Thanks!

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Hi Paula,

The care of a dying patient CPG states that it is a guideline for wards and critical care areas of the hospital. Considering Tyler is being cared for in the community, would this still be appropriate? or is this where we are looking further into evidence based research of what would be more appropriate in the community setting?

Thank you in advance.

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Hi Paula,

My apologies if this has already been addressed. I would just like to clarify whether or not vital signs assessments were ceased intentionally? The case study does not provide vital signs assessments past Thursday 19th March. However on Monday 29th a RR of 5 is recorded so I am confused.  I understand that vital signs can be intentionally ceased when they are no longer needed. However, Tyler was not declared to have entered the Terminal Palliative Care Phase  until Sunday afternoon and they appeared to have ceased before this.. Additionally, in the last full set of vital signs provided, signs of clinical deterioration were evident and many of these were not investigated further/acted upon. I would like to critique this as an omission of care in the Unstable Palliative Care Phase however am not sure if I have just missed something?

I hope this makes sense. Thank you for your help in advance.

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Hi Paula,

I was wondering with End Of Life Care, the first guideline states "Recognise patients who are at risk of deteriorating and dying." Does this mean discuss the guideline regarding when he was diagnosed or during throughout the case study when he is identified as "unstable" then "terminal" ?

Many thanks

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Hi,
Could you please list the references for the case study and the Advanced Care Directive please :)

thank you

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Hi, under the 'collect cues and information' tab, what day is it during the community nurses' 24-hour period? I understand that when critiquing we must be time specific of the episodes of care we want to critique.

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Hi,

I've noticed some people talking about having to discuss 4-6 episodes of care to critique against the CPG and standards however I don't believe I've read that anywhere before, is there another document discussing things like this that are expected somewhere? It sounds super helpful!

Thank you!

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I would like to argue some of my points around what is missing from the case study - eg setting goals and communication by HCPs with Tyler... Can I make the assumption that if it is not in the case study it did not happen?

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Hi Paula, I have criticized the care that has not been provided in relation with the Advanced care directive and communication which is also main part of CPG end of life care. would that be enough to criticize or it should be more broad? Thankyou

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Hi Paula, I have criticized the care that has not been provided in relation with the Advanced care directive and communication which is also main part of CPG end of life care. would that be enough to criticize or it should be more broad? Thankyou

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Hi!
I was wanting some feedback on my possible structure of my essay.
I'm thinking of choosing an episode of care from each palliative care phase that was mentioned in the case study.
Additionally, this would utilise Caring of the Dying Patient CPG
Any apprehension to this idea or am I all good to go? anything I should add?

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Hi,

I just wanted to ask, what happened to Tyler's PEG site infection? It lastly says on Wed that it appears less inflamed with redness being subsided a little; is it correct to assume that the infection was not completely resolved? Did this infection affect his further deterioration?

Thank you for your help.

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Hi, previously when asked on the padlet if headings were allowed the answer was yes if we felt they were appropriate. This is how I chose to structure my essay. Now, it says specifically no headings which I feel is rather unfair as this was not the original answer. Will I be penalised for using level 2 headings to organise my essay?

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Hi Paula,

I have asked these questions previously however it was deleted so my apologies if you have already answered this.

Can we assume the following-

Tyler was unable to donate his organs as he passed at home?

No specific palliative care assessment were completed Wednesday or Thursday in the case study?

And would it be correct to assume that no family meetings were arranged?

Thank you for your help in advance :)

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Hi!
Just to clarify, text books (like Brown et al. used in the case study) and databases like CareSearch (used in the modules) are appropriate to use as references in our assignment?

Thank you!

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Hi just a question regarding AT2.

Are we critiquing the care given based on the case study in line with the chosen CPG?

Besides referenceing this with the national palliative care standards and the CPG and Case study itself, what other references are required? if we are critiquing the care i am confused as to what references we should be including? Are we meant to provide up to date reasearch on what should have been done? or supportive evidence with what is good and bad in the CPG?

very confused as to sources.

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Hello NRSG374 Students, the previous question and discussion column for the AT2 forum is currently not accessible, we are working on a Q&A fact sheet of the most frequently asked questions for AT2 please continue to add questions and discussion here and we will respond accordingly. Thank you for your patience Erica (NLIC)

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Hello NRSG374 Students, the previous question and discussion column for the AT2 forum is currently not accessible, we are working on a Q&A fact sheet of the most frequently asked questions for AT2 please continue to add questions and discussion here and we will respond accordingly. Thank you for your patience Erica (NLIC)

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Hi,

I am hoping to get some clarification regarding the use of Tyler's advanced directive (AD). Upon research and experiences with palliative care, ADs cannot be used unless the patient loses capacity to make decisions and the ability to communicate (including speech, motor skills and eye movements - specific to ALS). Considering this and that Tyler never loses capacity and continues to communicate until the day before his death, does this mean we cannot critique the care provided against the AD?

Obviously there are some clear discrepancies between the AD and care provided, but my understanding is that ADs cannot be used in this scenario. I have researched this extensively, clarified with a palliative care nurse and emailed my LIC with no response, so would really appreciate your assistance. Thanks

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Hi Paula, I cannot see the previous question and answer that has been asked for assessment 2 in the padlet.

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Hi Paula, I cannot see the previous question and answer that has been asked for assessment 2 in the padlet.

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Hi Paula,

In the identifying issues section of the case study it says

Many of these are continuously being assessed and monitored:

Falls Risk Assessment

Braden Pressure Risk Assessment

Pain Assessment

NOK contact details

Advanced Health Care Directive

Modified Karnofsky Score of 30-40

RUG- ADL 17

SAS Tool Completed

There is no evidence through out the case study that all of these were continuously completed. Does this statement mean that they should be completed continuously within the palliative care setting or does it mean we should assume that these assessments were appropriately taken and interpreted?

Thank you
Thank you

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Can we critique whole case study care continum referring to MND input or only nursing care is supposed to be critique ?

My question here is insertion of gastrostomy for dysphasia
looking at the current study modified food reduces quality of life and potential risk to benefit would be considering infection through the site of insertion to quality of life of a patient?
was there need to involve speech pathologist where his swallowing assessment would have been carried out to measure possibility not to insert gastrostomy tube.

is it ok to critique this practice with suppporting articles?

another question would be a patient vital signs when firstly visited was not excelated?

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Patient Notes from Community Nurses over 24 section-hour Period: Patient appears in discomfort. Paracetamol 1gram given via peg. Oramorph 5mg given via PEG.>>> is it correct to assume that the RN didnt use a pain score tool?

Thursday afternoon section-The RN spoke with Catherine regarding contacting Tyler’s extended family. Time was spent with Catherine talking about Tyler’s condition at present. Tyler was orientated to person, place and time.Catherine did not want to share this time with Joyce and Tyler’s brothers and therefore she did not contact them.>>>> Are RN's allowed to rely on the patients family like this?

Break through intermittent pain relief, intermittent use of CPAP>>>Tyler requested for more analgesia for his increased pain and discomfort and discontinued use of CPAP. therefore, i would like to know whether the intermittent pain relief is his regular dose or a higher dose

Sunday afternoon section- he just wanted it all to be over.>>> this could mean many things. Is he suicidal at this stage?

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Hi,
It appears the link to the "Care of the Dying Patient CPG" from the last page in the booklet (https://leo.acu.edu.au/mod/book/view.php?id=3754387&chapterid=372434) attempts to load the file from last years module which of course we don't have access to (NRSG374 P OF NURS PALLIAT APPROACH 2020 Semester 2 National).
Can you please update the link so that we have a CPG to critique against?
Regards,
Stu

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I am just wondering how many palliative care standards we are expected to discuss.
Is an in depth discussion on 2 of the standards sufficient? Based on the word count and the number of different topics we are required to discuss?

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i just have a few questions regarding structure as i am a bit confused.

so for this assignment we critique 4-6 episodes of care where there are issues that based of the CPG we believe can be done better etc., within this can we say what they did well as well as not or would you like us to focus on the negative?

then we justify any interventions we made in their care using the standards (NMBA, palliative care standards ETC.) as well as contemporary references and the CPG

as well and throughout the critique put in our understanding of the disease MND is this okay or would you like a more specific approach?

is there anything more i feel like there is something missing?

sorry for the very long question

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Hello!

I have a few questions regarding some of the information given in the case study that I would like clarification on if appropriate.

- There is no day of the week attached to the vital signs we are given however the following information is stated as being on the Wednesday afternoon, can we assume that the vital signs listed are from the Tuesday before Tyler passed away?

- Regarding the second medication table, there is no frequency documented for the IV paracetamol, is this intentional?

- Also, the list of prompts for considerations of us as the RN discusses the palliative care phase of the patient, is it appropriate for us as the RN to document and determine the phase or is that a responsibility of the MO?

- One of the prompts under QOL Considerations asks if an adequate pain scale was used and if the use of the SAS scale as adequate and appropriate, however I cannot find any use of these tables in the case study apart from the numerical mention of the scores at some points, is there a filled out example of these tools to be used in conjunction with the case study?

- Finally, the CPG Care of the Dying Patient states it is to be used in critical care areas of a hospital (ie. ICU), is it still appropriate for us to use this CPG in a community palliative setting?

Thank you so much for answering all of our questions regarding this assignment it really helps a lot!

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Hey!
Sorry for the super long question! Just thought I'd get them all out of the way now.

Point 1 - I am just looking for some clarification regarding how limited we are when discussing a CPG that isn't necessarily included in the CPG we have chosen. For example, there hasn't been a specific conversation regarding to Tyler's end of life care, which would relate to End of Life CPG but it also impacts the Care of the Dying Patient CPG as no actual plan has been discussed. Do we still address this if our CPG is care of the dying patient even though there isn't any specific reference to establishing EOL care like there is in the end of life CPG? Sorry if that doesn't make sense, I'd be happy to clarify.

Point 2 - Is the actual timeframe for Tyler's end of life subjective or is it specifically when death is undoubtedly near (e.g. Wednesday 12th Vs Sunday afternoon). The research I've found varies so I'm not 100% sure. He is obviously really unwell and not recovering properly by Wednesday but life-sustaining treatments like the PEG feed is continued until Sunday afternoon. Does the decision rest on us as long as we back it up with evidence? Or is there a set time-frame that I'm just missing. As our whole critique depends on what part/time frame of the case study we are looking at, I guess I am looking for some clarification if we were to chose Care of the Dying Patient CPG.

Point 3 - Because there is no evidence of a SOC within Tyler's final days, can we assume an SOC wasn't completed and the conversation/planning with his family didn't occur? I just wanted clarification because the case study does mention the nurse had a conversation with Tyler's wife but I wasn't sure if it was structured using an SOC and if any goals were actually established during this conversation.

Point 4 - I understand in Tyler's ADC he states he doesn't want any ventilator assistance but he does regularly use a NIV. Can we assume he either didn't know the difference when making the ADC or he has chosen to not include the NIV in his definition of ventilator. (I'm aware they are very different but not sure if in this case Tyler is aware of the difference and if he'd class NIV as a ventilator and he is only using it because he is being told to by the medical team).

Point 5 - When the case study says Tyler was 'repositioned by the nurse' would this mean he is totally unable to mobilise and therefore any treatment regarding prolonging life should have been ceased then as stated in his ACD (or at least a discussion should have been encouraged)?