Welcome to this advance care planning resource for community and district nursing professionals.

Watch the video below from Dr Gary Mitchell providing a welcome and brief overview to the resource.

How will this resource help me in my role?

This resource will help you to introduce and facilitate advance care planning discussions with people receiving care and those important to them.

Engaging proactively in these discussions, even if an individual decides not to develop an advance care plan, can reduce uncertainty about future care, and improve the health care experience for the individual and those important to them.

This resource will:

  • Build on your existing knowledge, skills, and competencies in advance care planning.
  • Equip you to have advance care planning discussions in practice and help you overcome the main challenges.
  • Provide you with a practical resource you can refer to at any time.
  • Provide you with access to information for patients and those important to them. This information can be used to raise awareness or prepare individuals for an advance care planning discussion.
  • Demonstrate leadership in ACP via the sharing/signposting of this resource to other colleagues, care recipients and close support who may benefit from information on the ACP process.

The Nursing and Midwifery Code (NMC)

You will also find this resource relevant to the Nursing and Midwifery Professional Standards of Practice and Behaviour — prioritise people, practice effectively, preserve safety, professionalism, and trust.

Prioritise people: advance care planning helps deliver holistic care, ensuring people are treated as individuals, their preferences and concerns are listened to and the need to act in the best interests of people is considered and discussed.

Practice effectively: advance care planning provides an opportunity to assess future care needs and advise on realistic treatment options, ensuring decisions regarding future care are based on a comprehensive assessment of the patient's physical, psychological, and social needs.

Preserving safety: advance care planning ensures health care professionals engage in open and honest discussions with those receiving care, providing accurate information about care options and potential risks and benefits to support informed decision-making.

Promoting professionalism and trust: advance care planning promotes professionalism by upholding the principles of respect, dignity, and person-centred care, empowering patients to express their preferences, values, and goals for their future care. It also fosters effective communication, respecting autonomy while considering ethical and legal responsibilities.

How is the information in this resource delivered?

  • The information is designed to be practical and digestible; it is delivered across seven bite-sized units.
  • You can complete each of the seven units at your own pace and at a time convenient for you. We anticipate that each unit will take you approximately 10-15 minutes.
  • Each unit is made up of brief text, videos, and short reflective activities to allow you to think about how this learning applies to your work setting.
  • A certificate of achievement is available upon completion of the seven units. This will enable you to use it towards your continuing professional development (CPD).

You will have the opportunity to provide feedback about your experience of the resource at the end of the final unit. This will help us evaluate this digital tool, so your feedback is important to us.

Definition of terms

We have provided an overview of the language used in this resource below and included an interpretation of the technical terms used in a Glossary, which is available to view in the resource section.

Language

Throughout this resource we have tried to be consistent with the language we use. The terms may be familiar to you, or you might have words that you prefer, which more accurately reflect your circumstances. We recognise that this language is not universal, but we hope the terms we have used provide clarity.

We use the term advance care planning.

You may use or prefer future or anticipatory care planning. There can be small differences between the two, but for simplicity, we use advance care planning throughout and intend this to be inclusive of anticipatory care planning, future care planning and goals of care.

We use the term individual receiving care.

To refer to the individual receiving care from a community nurse and who the advance care planning discussion related to.

We use the term those important to the individual.

To refer to a partner, relative, loved one, friend or caregiver who is actively involved in decision-making support for the individual receiving care.

Reflective Practice

Reflection is an important part of nursing practice. Look out for the ‘reflective activity’ sections throughout this resource. These activities provide you with an opportunity to process your thoughts about advance care planning, the resource content and how you could apply what you have learned in practice.

Reflective Activity

Before moving on to Unit 1, spend a few minutes thinking about your role in relation to advance care planning and what you hope to get from this educational resource.

We have included a few questions below to help you with this activity. Please make a few notes when thinking about these questions. You will be asked to revisit these notes at the end of the resource.

  • What comes to mind when you think about advance care planning?
  • What does the term ‘advance care planning’ mean to you? What does it include?
  • How confident do you feel having a conversation about advance care planning? Are there any aspects you find/think would be challenging?

Ready to start? Click the button below to begin Unit 1