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Bijlage 1: Veelgebruikte documenten in het kader van vroegtijdige zorgplanning

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Bijlage 1: Veelgebruikte documenten in het kader van vroegtijdige zorgplanning



Datum12.03.2017
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Bijlagen

Bijlage 1: Veelgebruikte documenten in het kader van vroegtijdige zorgplanning

Bijlage 2: Vorming “Vroegtijdige zorgplanning in het WZC”

Bijlage 3: Transcript “Dying Well” Insoo Kim Berg

Bijlage 1: Veelgebruikte documenten in het kader van vroegtijdige zorgplanning

Vroegtijdige zorgplanning Ventilatiefiche



Naam

Voornaam

Geboortedatum

insz

WZC

Afdeling

Kamer

opnamedatum



Tum

Naam / Functie

Inhoud

VZP Communicatiefiche

Identificatie patient : naam voornaam geboortedatum INSZ

WZC - afdeling - kamer - opnamedatum



Datum initiatie VZP :

Doelstellingen VZP

Code A (Alles doen) maximale zorg ziekenhuis + WZC




Code B (Behoud functies) BH :beperkte zorg ziekenhuis (voor specifieke functie) + maximale zorg WZC

BW: in principe geen ziekenhuisopname gewenst




Code C (Comfortzorg) Palliatieve zorg WZC – Geen ziekenhuisopname gewenst tenzij voor comfortzorg






Doelstelling

Behandeling

Onderzoek

Verpleging

Kine

Ergo

Voeding

Code A

Voluit

Voluit

Voluit

Voluit

Voluit

Voluit

Code B H

Minimale belasting

Hospitalisatie

Voluit

Voluit

Voluit

Voluit

Code B W

Minimale belasting

Ambulant

Voluit

Voluit

Voluit

Voluit


Code C

Palliatief

Palliatief

Comfort

Comfort

Comfort

Comfort



VZP-code

Datum

Verantwoordelijke VZP

Confirmatie (huis)arts













DNR beleid




Code 0 Geen beperking – maximaal curatief




Code 1 Do Not Reanimate – geen reanimatie – verder maximaal curatief




Code 2 Geen uitbreiding therapie




Code 3 Afbouw therapie



DNR-code

Datum

Verantwoordelijke VZP

Confirmatie (huis)arts













Confirmatie




Naam

Datum

handtekening

Bewoner











Wettelijke vertegenwoordiger










Vertegenwoordiger











VZP DOCUMENT : WETTELIJKE VERTEGENWOORDIGER

Ik, die onderteken, wijs de volgende persoon aan als mijn vertegenwoordiger voor het geval ik niet zelf mijn rechten als patiënt kan uitoefenen


Naam en Voornaam










Adres










Telefoonnummer










Rijksregisternummer




Opgemaakt te op

Handtekening patient




Aanvaarding

Ik, …………………………………………………………………………………………….aanvaard de

aanwijzing als wettelijke vertegenwoordiger en zal naar best vermogen

…………………………………………………………………. vertegenwoordigen, met eerbiediging van

de wilsverklaringen in dit vzp document.

Opgemaakt te op



Handtekening wettelijke vertegenwoordiger




Wilsverklaring inzake euthanasie bij onomkeerbaar coma

Deze rubriek dient enkel te worden ingevuld indien men uitdrukkelijk levensbeëindiging wil wanneer men in een toestand van onomkeerbaar coma is beland.

Houd er rekening mee dat een wilsverklaring inzake euthanasie maar vijf jaar geldig is en na vijf jaar moet worden herbevestigd. Ze kan ook op elk moment worden ingetrokken of herzien.

Ik, ………………………………………………………………………….die onderteken in volle bewustzijn

Verzoek, voor het geval ik niet meer in staat ben mijn wil te uiten, dat een arts euthanasie toepast, indien voldaan is aan de voorwaarden gesteld in de wet van 28 mei 2002 betreffende de euthanasie.

Herbevestig de wilsverklaring tot euthanasie, opgesteld op ……………………………………

Herzie de wilsverklaring tot euthanasie, opgesteld op ……………………………………..

Trek de wilsverklaring tot euthanasie in, opgesteld op ……………………………………...

(Schrappen wat niet van toepassing is)

Opgesteld te op



Rijksregisternummer


Handtekening

Door de handtekening van twee getuigen, waarvan minstens getuige 1 geen materieel belang heeft bij het overlijden, wordt bevestigd dat deze wilsverklaring inzake euthanasie vrij en bewust werd afgelegd.

Getuige 1

Naam en voornaam




Adres




Rijksregisternummer




Graad van verwantschap




Handtekening




Getuige 2

Naam en voornaam




Adres




Rijksregisternummer




Graad van verwantschap




Handtekening




Bijlage 2: Vorming “Vroegtijdige zorgplanning in het WZC”

Bijlage 3: Transcript van gedeelten uit “Dying Well” Insoo Kim Berg

In deze opname spreekt Insoo met een ‘working girl’ – prostituee met sinds 7j een diagnose aids en een beperkt levensperspectief. Ze werd seksueel misbruikt door haar broers, verloor het contact met haar familie en werd ernstig mishandeld door haar pooiers.

Het gesprek draait rond de voorbereiding om rustig te kunnen sterven.

Ik geef geen geheel letterlijk weergave. Waar ik delen oversla gebruik ik volgend symbool (…).

‘I’ staat voor Insoo

‘T’ staat voor Tania, de cliënte.

I: So Tania, what kind of… What do you do?

T: Well I’m a working girl, a prostitute

I: oooh, you’re a working girl. And you live alone?

T: Yeah, Yes, I do now

I: Do you like it?

T: Not much, but my pimp, I’m too frightened, I can’t live with a pimp, I just told him I’m not gonna work, if he lives with him if he keeps beating me up. So I’ve left him.

I: You have? Wow! That must have taken a lot of courage on you’re part to have done that

T: He keeps beating… I’m gonna die anyway soon, but I don’t want him to keep beating me. But in a way it doesn’t matter anymore cause I’m gonna die. I’ve got aids.

I:ah, you’ve got aids. When did you find out you’ve got aids?

T: seven years ago I was tested positive

I: wow, that’s a long time isn’t it?

T: Yeah it is, and the way I was tested. I came in the hospital after I was beaten up, and they tested me without telling me.

I: Ah, you didn’t wanna know?

T: no (…)

I: So, I’m just wondering about this. How have you been managing?

T: Well, I’m still working…

(…) (gedeelte rond hoe het werk nu verloopt)

I: I’m just wondering about this Tania, before we get into this too deep. What would you suppose to like to see happen by coming here today?

T: I’m gonna die soon, I’ve had a lot of abuse in my life, I want to clear it up. I want to get rid of everything. I’m planning on dying. I’ve only got probably only 6 months at the most. I’ve been diagnosed a long time

I: You’ve last a long time. So, What tells you you’re gonna die in 6 months?

T: The doctor, I have had pneumonia lots of times and got through it.

I: You did? wauw!

T: Yes, I do take care of my self from time to time

I: Yeah, you must…

T: I go for check ups regularly (…)

I: The last time I got what the call (?), it’s everywhere (…)

I: That’s when they told you…

T: Yes (…)

I: So before you die, you’d like to…

T: Just, get, … I don’t think I’ve ever told my brothers how much I hate them for abusing me and my stepfather. I just want to get rid of it all, I want to tell somebody

I: So telling somebody would help you get rid of it

T: Yes, I’ve been abused for such a long time by (…) I just want to get rid of it

I: So coming here and talking about it is your way of getting rid of it

T: Yes they say, I’ve read, that writing, having family meetings would help, but I don’t think I’m strong enough. I’m not well enough. The clinic told me I should do that but I’m not ready.

I So suppose you would get rid of this at the end of talking, what difference would you suppose that would make for you

T: I think I could go home and say goodbye to my mom. I need to do that.

I: You would like to do that.

T: But I can’t do that. Cause my brothers there and so is my stepfather.

I: Somehow getting rid of it would help you to say goodbye to your mom. I don’t understand how that would be helpful to you

T: They tell me at the clinic, that if I face it (…) If I face it, then it would all go. I would be alright. If I go and talk to them(…)

I: What do you mean it ‘ll be alright?

T: They want me to tell them how I feel about them, how much I hate them.

I: You don’t think it will be ok for you

T: No I don’t see how just telling them how much I hate them… It will just bring everything up. They don’t understand what they’ve done wrong….

(…) (gedeelte rond misbruik in thuissituatie)

I: I’m still wondering about this

T: And they still keep telling me I’ve got to talk to someone, that I need to tell someone in big detail. But I can’t, I’m too tired. I’m gonna die soon. They keep telling me I’ve got to do this before I die.

I: Do you agree with that part that you want to do this before you die?

T: I know that I ‘ve got to see my mom before I die

I: That’s something you know for sure, you would like to do. So suppose you talk it over and they will allow you to go over and visit your mom and say goodbye to you mom. What difference would this make for you?

T: I would be at peace. I would have done everything. I’ve given up drugs. I had a plan. Yeah I gave up cocaine.

I: My goodness. By yourself?

T: Yeah, well with the clinic, the program for drug dependency.

I: That’s amazing

T: Yes I suppose it is. I’ ve given’ up cocain

(…)

I: (…) So saying goodbye to your mother how would that be helpfull you?



T: Well I had a plan. I wanted to do certain things before I die. To say goodbye to things. Just to let go. And one of these, I haven’t seen my mom in 20 years. I think I need to see her. She knows im ill but she doesn’t know how ill.

(…)


I: (…) So how would talking to her be helpful for you.

T: She…When I left, I was taking drugs, I was a working girl, I was living on the streets; but since then I got somewhere to live, I’ve given up drugs and I’ve got a regular income. I do take care of myself. I need to show her that I’m not what she thought I was


I: So that’s important for you, For your mom to know that you’re doing better then she saw you 20y ago. What do you suppose she would do, when she finds out you’re doing better, and you’re not what she thought you was.

T: I hope she’ll be pleased. I hope she lets me stay with her

I: Stay with her during your visit, or come to live with her

T: No, during my visit, (…) she wouldn’t be able to cope



I: You don’t want to do that to her. Wow, you must love her very much, you must care about her very much

T: Yeah but she dumped me. I do care about her, but she dumped me

I: She doesn’t’ know how important she is to you

T: No and she didn’t care about me. She didn’t stop the abuse (…)

I: You are a though lady aren’t you, Tania

T: I don’t know, I’ve never thought about it that way.

I: You took care of yourself since you were very small

(…)


I: You’ve come a long way

T: Yes, but I keep forgetting that. They keep telling me how terrible I am

(…)

I: So, how did you manage not to listen to all those people telling you how terrible you are? How did you manage not to listen to it and believe it.



T: I just didn’t

(…)


I: How did you do this?

T: (…) I just thought how was I gonna manage tomorrow?

(…) (gedeelte over hoe ze weg is gegaan van pooier)

I: How do you keep going?

T: It’s very hard. I’m very sick in the morning (…) ; some days I stay in bed all day, but then I have to work. Then I can’t get any food, can’t pay rent

(…)


I: So how do you manage…? What stops you from just giving up and saying I can’t work. How do you keep going? How do you get out of bed?

(…) (Tania vertelt hoe andere meisjes al eens nagaan hoe het met haar gaat+ de kliniek)

(…)

I: How is that helpful? (…)



T: It might mean that I’m not that bad as my brothers have always told me when I was little

I: So I guess this goes back to the same thing, that you’d like your mother to know that you’re not so bad as she thought you was. It sounds like that’s really important for you.

(…)

I: So suppose, that your mother is convinced. She would finally see that you’re a good person inside. What difference would this make between you and your mom?



T: I don’t know. It may not make any difference really. She may not wanna know. It’s a long time ago, but it’s something that I cannot forget. And maybe, just maybe, she’ll say sorry, but I don’t know. Maybe my brothers would say sorry, but I don’t think so

I: She would say sorry about what? What you went through or the fact she didn’t protect you? What would she say sorry about?

T: About what I went through.

I: So she would know what you went through. And that would be helpful for you

T: I don’t want to just hurt her, I just want her to know

I: What would be the chances (…) for her to finally knowing what you went through?

T: When you put it like that, I just don’t know. Cause she didn’t want to know all those years ago. I’m a bit confused now. But all these aids-places, they tell me you should face everything, you need to get your will out, start writing, and face everything, but maybe when you put it like that I don’t know.

I: So what will be helpful for you?

(…)

T: Maybe just sorting it out myself… instead of talking to all these people. They want me to write letters and draw pictures. I don’t know if I can do it, I’m just not strong enough



I:Now, what do they tell you that would be different for you if you write these letters, draw these pictures and tell them what happened to you?

T: They tell me I can die peacefully when I do all the things I set up

I: So aside from what they tell you, what do you think you need to do so you can die peacefully?

T: If you put it like that… maybe just think about it myself and not tell all these people what I’ve supposed to have done or what they supposed to have done. Maybe just think about it in my own way… cause I’ve got, I don’t know if I can travel 200 miles which is where my mom is

I:You think it would take a long, large stress on you part to travel that much. So what’s important to you is that you want to die in peace for yourself. Peace for yourself, for you. And somehow thinking it over might be able to help you to die in peace

I: Suppose you die in peace, somehow you have been able to arrange it in your life in such a way, at six months, suppose you die in peace. Can you say something about it? How it will be like for you? How will you know that you die in peace?

T: Mmm… I would have said goodbye to everybody that I wanted to: whether that’s actually really saying goodbye, or whether I can just think I’ve said goodbye, I’m not sure there. I do need to write a will. I need to know what I’m gonna leave anybody. Just to have a little list of things that I have to do, I need to make sure that my friends don’t worry about me anymore. I need to write to them. Maybe just write to my mother, just say goodbye, maybe…

I: And do you know what you want to say in these letters, to your mother, your friends and people who are concerned about you?

T: Just that I did try, that I did give up drugs, I did find somewhere to live. I was abused but I’m still here. That I didn’t kill myself, even though I tried.

I: I don’t know how you did that. I’m just absolutely amazed how you did that all by yourself…. So somehow you want them to know that you’re a good person. And somehow that’s important for you. Do you know what we, What do you have to do to do that, to write these letters? Let them know?

T: Maybe just sit down one night and think about it. Maybe that’s the first thing. Maybe decide whether I’m going 200 miles to see my mom or not. Decide on that, now that would be hard.

I: (…) (vat samen). Ok, well. I guess you know how to do that. To pick a date and decide. How will you go about deciding? What will help you decide whether you’re going to make the trip or write the letter?

T: Mmm I don’t know, cause I guess I’m gonna have to do that soon. Cause I will be to weak. I don’t know

(…)


T: I think I have to work this out at the beginning of the week when I’m a little bit stronger.

I: So you’re a little bit better at the beginning of the week than toward the end of the week

What’s different at the beginning of the week?

I: I don’t know really, I just seem to feel a little bit better, maybe I’m not so tired. I work a lot at the weekend, I go out a lot, I don’t know. I just feel a bit stronger.

(…) (over meer werken en klanten)

I: So the beginning of the week is easier for you to make a decision about it. Does that mean because you have a little bit more time to think about which way to decide. Whether to take a trip or not or… Is there anything else you need, that would help you decide which way to go?

T: Maybe if she ever got in touch with me, that would make a difference.

I: Mm, your mom, getting in touch with you? Does she ever do that?

T: Not for a long time now, maybe it’s just a hope

I: So it’s not very likely

T: No, not really

I: Let me ask you, it sounds like a little bit of a strange question, but bear with me on this.

Let’s say that after you and I talk to day, you’re going to go back to your hotel, and after you’re working, you go to bed tonight and while you’re sleeping some sort of miracle happens… that would be nice? And the problem, the concerns that brought you here today, it’s all taken care of, it’s all solved. Because you’re sleeping you don’t know. So when you wake up tomorrow morning how will you know that the concerns are gone, the problem is solved, it’s all gone?

T: Well, I would be wauwed. I wouldn’t have aids. I wouldn’t be dying. I had a proper family life. I wouldn’t’ worry about them, I would have, I would be able to contact my brothers and my mom, and my stepfather and they wouldn’t have told me for years how terrible I am.

I: What would they have told you instead of how terrible you were?

T: That it was worth having me around

I: Ah! So they’re glad that you came to the family, you were born to the family. Suppose they did, suppose somehow they let you know, that they were glad that you came to the family. That it was good to have you around. What difference would that make for you?

T: I would have gone to school, I would have got an education I would have passed my exams, I got there everyday instead of running away from home every day

I: What else, what other kind of difference would that make for you

T: That I would go out, that I wouldn’t have friends who are working, I suppose. I’d lead an average life, not have to be on the streets everyday

I:So you would not be a working girl

T: I wouldn’t worry about being killed, beaten up

I: What else would you be like. Suppose your family told you… How would that change you

T: I’d be more confident, I would be able to say no.

I: To?

T: To people who want to harm me



I: Ah ok, … But you’ve done that to the pimp..

T: I suppose yeah, I suppose I have

I: You have… He’s leaving you alone, he’s letting you live in a hotel. How have you done that? I’m still absolutely amazed bout this, you were able to do this. How you’ve done this? How you’ve got of cocaine? Do you know how you’ve done this…?

I: Not really, no

(…)

I: So without having had that from you’re family, without having being told that you’re a good person… How have you managed to be such a strong, good person underneath? How have you done this?



T: Is think it’s because I had to. I had to manage every day . I have to live every day, I have to look after myself every day.

I: So, how come you didn’t turn into a bad person, inside? I know you had to survive. It sounds like you’ve done more than that. You, somehow, inside you, there’s this good person inside. I don’t know how you’ve done that.

T: Mmm, I don’t know.

I: It’s a puzzle to me

T: I don’t know…I think maybe I wasn’t going to let them win. Maybe I wasn’t going to prove them right. I was gonna prove them wrong.

I: Wauw


T: Maybe that’s it

I: Mmm, so you knew this al along that you were not going to prove them right. That you disagree towards their ideas about who you are of what you’re like.

T: Maybe it wasn’t (…). Maybe I was angry to them. They harmed me so much (…)

I: Incredible.

Inleiding op therapeutische break (…)

I: Is there anything that my people should know that I didn’t get to ask?

T:… maybe that my bloodcount is so low that I shouldn’t be walking around…

(…) (Had allerlei verwachtingen over wat anderen voor haar konden doen, maar na gesprek niet meer, geeft aan dat ze zich wat meer vredevol voelt/ rustiger over alles)

BREAK

I: Well, we had a long discussion. We really had to say a lot about you…



First of all we wanted you, the team wanted to

Shake you’re hand on behalf of the team. They wanted me to tell you how impressed they were with you’re strength, incredible strength, that you’ve survived all this. And you also have given lots of thoughts, you’ve thought about your life and you have lots of ideas how you want to end your life, how you want to die in peace. And what’s incredible about it is that in the middle of all these ideas that people have been telling you about, at the clinics, that you want to find your own way in, what is right for you, what makes sense to you, what feels comfortable for you. And we absolutely agree with that, whatever you choose to do, it should feel right for you. So I guess you have enough sense to know that telling your brothers about what they have done is probably not right for you. And you’re not ready for that and you have enough trust in your own intuition to know that’s not good for you, that’s not the way you want to do it and you want to find your way. It seems like again, in spite of the fact that you’ve been terribly abused by many people, mistreated by many people… not only are you still here but also that you know that there is a good person inside. And you know that, and you’ve been able to maintain that, in all this difficulties that you’ve had. You’re also incredible strong, you’ve not only survived, you’ve done more than that,. That you’ve been able to say no to cocaine, able to say no to the pimp and you’re saying no to all these people who are telling you how to do and you’re saying: no, I’m gonna find my own way. We think it’s just absolutely wonderful. The one last thing they wanted me to let you know they got inspired by you, you have really affected them, your story is such an inspiration. The only thing we want to suggest at this point is that you know what is right for you and you know what you need to do, what you like to do. So and as you continue to find your way of dying, I guess you need to continue to sort it out…

T: Yes, I think I’ve got a lot of thinking to do

I: Yes you do. And do you think it would be helpful for you to come back and so that we could help you to sort it out, or do you think you want do this on your own? What would be helpful for you?

T: I think I’m gonna come back once more, just to say that I done it

(…)


T: Thank you for not asking me to tell you everything


  • Identificatie patient
  • DNR beleid Code 0
  • Code 2
  • Wettelijke vertegenwoordiger

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