Waiting for guardianship in a public hospital geriatric inpatient unit: a mixed methods observational case series.

BACKGROUND: Patients in acute hospital settings waiting for guardianship and financial management (FM) hearings experience extended length of stay (LOS), with known consequences for frail elderly. This, together with universal agreement that substitute decision-making is a last resort measure, an imperative exists to examine guardianship and FM applications made from within hospital for geriatric inpatients. AIMS: This study aims to examine processes around Guardianship applications in a public hospital Geriatric inpatient setting including times to, reasons for and outcomes of referral; and to explore the content of the medical records in relation to criteria for application. METHOD: This was a mixed methods observational case series using descriptive data supplemented by qualitative case-note analysis of inpatients referred for guardianship (with/without FM) from 2018 to 2020 in a New South Wales Geriatric Medicine inpatient unit. Medical records were examined for evidence of operationalised criteria for guardianship, aligned with disability, capacity and need/risk common to most Australian jurisdictions. RESULTS: Of 45 patients with guardianship applications, 98% were granted guardians and 33 of 37 (89%) FM applications. Multiple risks underpinned applications, most commonly frequent falls (49%) and medication mismanagement (49%). Although only 29% were in receipt of services preadmission, 98% were discharged to residential care. Average hospital LOS was 70 days (interquartile range, 35), contributed to by delays between admission and decision to apply for guardianship/FM (median, 28 inpatient days) and uncertainties around or lack of documented capacity assessments. CONCLUSION: This study identifies potential points along pathways towards guardianship in hospital settings, which might be targeted to streamline if not divert some of these applications. Points of intervention include at initiation of applications, with consideration of alternatives to substitute decision-making by addressing patient needs and using supported decision-making, while improving clinician understanding of capacity assessment and guardianship.

[Advance directives in clinical practice : Living will, healthcare power of attorney and care directive]. / Vorausverfügungen im klinischen Alltag : Patientenverfügung, Vorsorgevollmacht und Betreuungsverfügung.

In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

[Advance directives in clinical practice : Living will, healthcare power of attorney and care directive]. / Vorausverfügungen im klinischen Alltag : Patientenverfügung, Vorsorgevollmacht und Betreuungsverfügung.

In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

[Advance directives in clinical practice : Living will, healthcare power of attorney and care directive]. / Vorausverfügungen im klinischen Alltag : Patientenverfügung, Vorsorgevollmacht und Betreuungsverfügung.

In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

[Advance directives in clinical practice : Living will, healthcare power of attorney and care directive]. / Vorausverfügungen im klinischen Alltag : Patientenverfügung, Vorsorgevollmacht und Betreuungsverfügung.

In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

Legal guardians understand how children with the human immunodeficiency virus perceive quality of life and stigma.

AIM: This aim of this study was to describe how legal guardians assessed health-related quality of life and HIV-related stigma in children with the human immunodeficiency virus (HIV) compared to the children's own ratings. METHODS: A cross-sectional nationwide study was performed to compare how 37 children aged from eight to 16 years of age with perinatal HIV, and their legal guardians, assessed the children's health-related quality of life and HIV-related stigma. Data were collected using the 37-item DISABKIDS Chronic Generic Module and a short eight-item version of the HIV stigma scale. RESULTS: Intraclass correlations indicated concordance between the legal guardians' ratings and the children's own ratings of the child's health-related quality of life and HIV-related stigma. There were no statistically significant differences between the ratings of the two groups and gender did not have any impact on the results. Both groups indicated that the children had concerns about being open about their HIV status. CONCLUSION: The results of this study indicated that legal guardians understood how their children perceived their health-related quality of life and HIV-related stigma. The results also indicated the need for interventions to support both the children and legal guardians when it came to disclosing the child's HIV status.

The principle of assessing mental capacity for enduring power of attorney.

With Hong Kong's rapidly ageing population, increasing numbers of people now have some form of cognitive impairment. Enduring power of attorney is a legal instrument that can allow individuals to manage their financial matters if they subsequently become mentally incapacitated. The law requires that the mental capacity of the individual making an enduring power of attorney should be certified by a registered medical practitioner and a solicitor. This paper discusses the principles involved in the assessment of mental capacity for making an enduring power of attorney and uses this example to illustrate various important considerations in the formal assessment of mental capacity.

[Guardianship law - what doctors and patients should know about the latest amendment]. / Das reformierte Betreuungsrecht und die Folgen für die Arztpraxis.

With the latest amendment of the guardianship law the German legislator means to strengthen the patients' right of self-determination. The most significant new regulations are the introduction of mutual legal representation of married couples in emergency and changes restricting the guardian's legal position. New challenges for doctors and lawyers arise especially from the legal representation of married couples. General practitioners who advise their patients with the preparation of provision documents should particularly explain the importance of recordations in the central providing register (ZVR).

Knowledge of, and participation in, advance care planning: A cross-sectional study of acute and critical care nurses' perceptions.

BACKGROUND: Nurses have a core role in facilitating discussions and enacting decisions about end-of-life issues for patients in hospitals. Nurses' own knowledge and attitudes may influence whether they engage in meaningful end-of-life conversations with patients. AIMS: To determine in a sample of nurses working in acute and critical care hospital wards: 1) their knowledge of advance care planning, including the authority of substitute decision-makers and legal validity of advance directives; 2) their own participation in advance care planning decision-making practices; and 3) associations between nurses' socio-demographic characteristics; clinical expertise; and knowledge and behaviour in relation to advance care planning practices. DESIGN: Questionnaire-based, cross-sectional study. SETTING AND PARTICIPANTS: The study was conducted with 181 registered and enrolled nurses employed in acute and critical care wards of three metropolitan hospitals in Australia. RESULTS: Nurses were least knowledgeable about items relating to the authority of medical (56%) and financial (42%) substitute decision-makers. Few nurses had prepared advance directives (10%) or appointed medical (23%) or financial (27%) decision-makers, when compared to discussing end-of-life wishes (53%) or organ donation (75%). Overall, 15% of nurses had not engaged in any advance care planning practices. Nurses who had cared for 11-30 dying patients in the last six months were more likely to have an increased knowledge score. Older nurses were more likely to participate in a greater number of advance care planning practices and an increase in shifts worked per week led to a significant decrease in nurses' participation. CONCLUSION: Nurses have a key role in providing advice and engaging dying patients and their families in advance care planning practices. Nurses' own knowledge and rates of participation are low. Further education and support is needed to ensure that nurses have an accurate knowledge of advance care planning practices, including how, when and with whom wishes should be discussed and can be enacted.

Avaliação do nível de conhecimento sobre Toxoplasmose por pais e/ou responsáveis de crianças em Centros Municipais de Educação Infantil em Foz do Iguaçu-Pr / Brasil / Knowledge level of toxoplasmosis by parents and/or legal guardians in child education Municipal Centers in Foz do Iguaçu, Paraná, Brazil

O objetivo deste estudo foi avaliar o nível de conhecimento prévio e a assimilação de informações novas sobre toxoplasmose pelos pais e/ou responsáveis de crianças matriculadas em Centros Municipais de Educação Infantil (CMEI) do município de Foz do Iguaçu, PR, Brasil. Trata-se de um estudo comparativo, descritivo e de abordagem quantitativa com 163 pais e/ou responsáveis por crianças em CMEI. Aplicou-se questionário contendo 12 questões objetivas sobre a toxoplasmose, aplicado em dois momentos sequenciais da pesquisa M1 (pré-intervenção educativa) e M2 (pós-intervenção educativa). Inicialmente, o questionário foi aplicado para a avaliação do conhecimento prévio sobre a toxoplasmose, seguindo de palestra referente ao tema e, ao término, reaplicado o mesmo questionário para verificação da assimilação das informações. Os dados foram analisados pelo programa BioEstat 5.0®, considerando-se um nível de significância de 5%. Foi identificado um desconhecimento de 62,6% dos pais e/ou responsáveis pelas crianças na avaliação no M1 para as variáveis investigadas (p<0,05). No M2, o percentual de respostas satisfatórias elevou-se consideravelmente (p<0,05). Este estudo evidenciou a necessidade de ampliação de conhecimento de pais e/ou responsáveis por crianças e a eficácia das orientações sobre toxoplasmose.

The purpose of this study was to evaluate the level of prior knowledge and assimilation of new information about toxoplasmosis by parents and/or legal guardians of children enrolled in Child Education Municipal Centers (CMEI) in the city of Foz do Iguaçu, Paraná, Brazil. This is a comparative study using a descriptive and quantitative approach with 163 parents and/or legal guardians of children in CMEIs. A questionnaire containing 12 objective questions about toxoplasmosis, applied in two sequential moments - M1 (pre-educational intervention) and M2 (post-educational intervention) was used. Initially, the questionnaire was applied for the evaluation of prior knowledge about toxoplasmosis, followed by a lecture on the topic and, at the end, the same questionnaire was reapplied to verify the assimilation of the information. The data were analyzed using the BioEstat 5.0® program, considering a 5% level of significance. The results identified a deficit of knowledge in 62.6% of parents and/or legal guardians in the M1 evaluation for the investigated variables (p<0.05). In M2, the percentage of satisfactory responses increased considerably (p<0.05). This study evidenced the need to increase the knowledge of parents and/or legal guardians of children and the effectiveness of orientation about toxoplasmosis.

Significados atribuídos à vacinação contra o HPV por responsáveis legais de meninas / Meanings attributed to HPV vaccination by girls legal guardians

Trata-se de pesquisa descritiva e qualitativa, cujo objetivo foi descrever os significados atribuídos à vacinação contra HPV por responsáveis legais de meninas, a partir do processo de interação social no contexto do câncer do colo do útero. Realizada em locais próximos a escolas, ruas, praças, residências, no período entre maio e julho de 2018. Foram entrevistadas 10 responsáveis legais de meninas. Foram atendidas as exigências do Conselho Nacional de Saúde e o projeto foi aprovado pelo Comitê de Ética em Pesquisa da Universidade do Estado do Rio de Janeiro sob o n.º 2.449.934. A análise foi baseada nos pressupostos da Grounded Theory, por oferecer elementos para a discussão dos dados de modo comparativo constante dos resultados, e do interacionismo simbólico, que possibilita que a pesquisa qualitativa atinja o objetivo de pesquisar o sentido que os indivíduos propõem aos objetos, pessoas e símbolos com os quais interagem no meio social. Emergiram cinco categorias: Categoria 1 Aderindo à vacinação contra HPV, Categoria 2 Sentindo preocupação e medo em relação a comentários sobre reações adversas pela vacina contra HPV, Categoria 3 Considerando escassas as informações veiculadas sobre a vacinação contra HPV, Categoria 4 Preferindo vacinar por conhecer a gravidade da doença, e Categoria 5 - Escolhendo esperar a criança amadurecer para tratar de assuntos relacionados ao sexo, assim como, optar pela vacinação contra HPV. Evidenciou-se que a vacinação contra HPV causa preocupações e inseguranças nas pessoas por a considerarem uma vacina recente, o que gera muita especulação social, contribuindo para veiculação de boatos. Observou-se também a carência de informações que os responsáveis legais de meninas alegam ter acerca da vacinação no contexto do câncer uterino, trazendo à tona diversas solicitações de mais informação sobre o tema. Trata-se de um assunto delicado, pois se refere a prevenção de uma doença sexualmente transmissível em crianças e adolescentes, o que é tabu para alguns responsáveis legais. Evidenciou se maior dificuldade de articulação do diálogo e de adesão na idade de 9 anos, pois os responsáveis legais consideram suas crianças muito jovens para tratar assuntos inerentes ao sexo. Por outro lado, muitos responsáveis legais mantiveram a decisão de vacinar suas filhas, referindo satisfação da implementação da campanha pelo Ministério da Saúde.

This is a descriptive and qualitative research, whose objective was to describe the meanings attributed to HPV vaccination by legal guardians of girls, from the process of social interaction in the context of cervical cancer. Held in places close to schools, streets, squares, residences, in the period between May and July 2018. Ten legal guardians of girls were interviewed. The requirements of the National Health Council were met, and the project was approved by the Research Ethics Committee of the State University of Rio de Janeiro under Number 2,449,934. The analysis was based on the Grounded Theory assumptions, as it offers elements for the discussion of data in a constant comparative way of results, and symbolic interactionism, which enables qualitative research to reach the objective of researching the sense that individuals propose to objects, people and symbols with which they interact in the social environment. Five categories emerged: Category 1 adhering to HPV vaccination, Category 2 feeling concern and fear in relation to comments on adverse reactions by HPV vaccine, Category 3 Considering scarce the information conveed about the Vaccination against HPV, category 4 preferring to vaccinate for knowing the severity of the disease, and category 5-choosing to wait for the child to mature to deal with sex-related subjects, as well as , opt for HPV vaccination. It was evidenced that vaccination against HPV causes concerns and insecurities in people because they consider it a recent vaccine, which generates a lot of social speculation, contributing to the dissemination of rumors. It was also observed the lack of information that legal guardians of girls claim to have about vaccination in the context of uterine cancer, bringing to the fore several requests for more information on the subject. This is a delicate matter, as it refers to the prevention of a sexually transmitted disease in children and adolescents, which is taboo for some legal guardians. It was evidenced that greater difficulty in articulating dialogue and adherence at the age of 9 years, because legal guardians consider their children to be very young to treat issues inherent to sex. On the other hand, many legal guardians maintained the decision to vaccinate their daughters, referring to the satisfaction of the implementation of the campaign by the Ministry of Health