Proven Initials Template with airSlate SignNow

Proven initials template

welcome to advanced care planning and personal directives this is a video presentation by the college of licensed practical nurses of Alberta and Alberta Health Services I'd like to introduce you our facilities for today it's Alexandra Koosh Lac that's myself and Jennifer's Elmer my background is Social Work and I've been in the field for over 35 years I've worked in various facilities from acute care to long term care and have helped many clients and patients to do a personal directive and of course I've got my own personal directive and have experienced it with it in terms of using it with family members and making sure that everybody that I know over the age of 18 have a personal director I'm gonna have Jennifer introduce herself and give a little bit of a background well thank you yeah hello my name is Jennifer Zellmer I'm your other facilitator for today and my background is nursing I've been a registered nurse for just over 15 years mostly in acute care working with adults I've kind of been everywhere from medicine to surgery to the intensive care unit and done a little bit of outpatient work as well I'm too pretty passionate about this topic because in combination with my professional career as well as in my professional life I've really seen how having a personal directive and how advanced care planning is really part of providing patient and family-centered care so we've been very fortunate fortunate to be invited by CLP innate to provide a series of video presentations for LPNs and Alberta so we've broken it up into three so today our first topic is going to be advanced care planning and personal directives so this graphic just kind of show us how all of these topics are really integral to providing care that's consistent with patient values and providing patient and family-centered care so we have advanced care planning which we're going to be focusing on today which is really a building block towards our goals of care and our health care that we provide to patients and then the documentation piece which is the green sleeve and the related documents really is the important part of communicating this important information with patients as they travel along in our healthcare system so again today as I mentioned we're going to be focusing on the advanced care planning part of that equation so the topic for today in kind of the plan for today's video is we're going to look at advanced care planning we're going to spend a lot of time going through advanced care planning on a personal level for yourself so talking about why it's important and we're actually going to give you the tools you need to write a personal directive for yourself if you haven't already done so then Alexandra is going to go through in a little bit more detail what you need to know about personal directives when working with patients or clients in your practice so to start off what is advanced care planning in general only about two out of ten Canadians really understand what that term means so basically what advanced care planning is it's a process where a capable adults plans for a time where maybe they're not able to make their own medical or personal decisions so it's basically thinking about your healthcare wishes thinking about what you may or may not want for healthcare treatment and talking with people close to you so they're aware of your wishes it's also about choosing somebody to make decisions on your behalf if you ever become unable to speak for yourself for some reason reason or whether that's temporary or something permanent and then the final piece is documenting this information in the personal directive which is what makes your advanced care plan legally binding so part of the reason why this is so important is because our healthcare system has changed so much in the last 75 200 years so the slide you're looking at right now is a death trajectory and this is where we used to be so this is set in depth so you know we're fully functioning and then something happens and we pass away suddenly and quickly and this used to be the norm most people died this way because medicine could do very little in terms of curing disease or illness really until after World War two so there's very little decisions to be made and people often passed away quickly from relatively minor things that were now able to treat so this is where we are now so looking at these three trajectories whether it's terminal illness organ failure or frailty this now accounts for over 85% of deaths and what that means because when you look at these three trajectories what they have in common is it's a longer period of decline over a greater period of time so when you combine that with the fact that medicine has so many more treatments options there's new drugs there's new trials there's new approaches that in combination with disease taking longer it means there's more decisions to be made and we can expect this for most of our patients and for ourselves as well so really makes advanced care planning quite relevant because we need to now be thinking about what we want for medical care because there's more decisions to be made so I'm asking planning involves five steps so you're gonna see them on your screen here so the first step is thinking about your wishes and values for healthcare so a great place to start with this is looking at your experience working in healthcare or thinking about experiences you've had in your personal life either for yourself personally or with those close to you experiences with being in hospital with being ill with that even thinking about what you felt was good medical care and what you felt was not good medical care it's a really good way to start thinking about what you may or may not want for yourself the second step is learning about your own health and this is really important so if you're if you're young if you're relatively healthy your advanced care planning is going to be very different than if you've been diagnosed with a disease or if you're facing end-of-life so if you're healthy really your personal directive and your advanced care plan is very future-oriented and thinking about well you know if this happened what would I want or what would I not want but if you've been diagnosed with something it becomes really important to learn about that illness and learn about what decisions might be coming down the road because ultimately if you're if you don't know what's going on with your health it makes it really difficult to plan so the third step is choosing that alternate decision-maker someone to make medical or personal decisions for you if something happened where you became unable to make your own decisions and in Alberta the legal term for this person is your agent and that's what I'll be referring to this person to for the remainder of the presentation is your agent so fourth step is community getting your wishes and values about healthcare it's really important for your agent to be aware of any healthcare wishes that you've you've thought about for yourself it's also really important for other people you're close to to be aware as well because if your agent or your loved ones ever had to make decisions for you they need to have an idea of what you would or would not want so I think the fourth step is probably the most important out of all of them and then the fifth step the final step is that end results which ends up being the personal directive so this is where you write down your healthcare wishes and you write down the name of your agent so that it's legally enforceable so when we educate the public because that's part of our role as well we find that there's a lot of confusion about the different types of legal documents that are used in alberta so we like to always start by doing a quick recap of the differences between them so in general you need three legal documents in alberta you need a will an enduring power of attorney and a personal directive and they all serve completely different purposes so a will it doesn't even get looked at until after we've passed away it has to do with our money and our estate after we've died so it has nothing to do with our health care which is really important for us health care providers to be aware of because oftentimes the public thinks that if they have a will it's the same as a personal directive so they might try to brush you off me like I have my will I'm okay so it's really important to know the difference to be able to tell people that a will is not the same and it has nothing to do with health care so the second document there is an enduring power of attorney so this document does come into play while we are still alive but it only has to do with financial or money decisions so an enduring power of attorney allows you to name a decision maker called your attorney but they only have authority over money matters so they can't make decisions about your health care if you've written their name in an enduring power of attorney so now the third document is the personal directive and this is the document that comes into play while you are alive but unable to make your own decisions about personal matters which includes health care a personal matter is anything that's non-financial so it's things like your health care where you can live who you can associate with can you go to school can you work maybe some legal matters so it's a wide range of decision so really really important to be sure that you have a decision maker in place that you trust so again just a recap what is that personal directive it is not the same as a will or an enduring power of attorney it has a very specific purpose it's a legal document that allows you to appoint your agent to make health care and personal decisions if you became unable and it's also the document where you can write down health care wishes that you would want people to know and follow if you were unable to speak for yourself and I should clarify that you can have the same person listed as an agent in your personal directive and this that same person can also be listed as your attorney in an enduring power of attorney so you can have the same person making different types of decisions for you but you would need to write their name down in in both documents so myself for example if I wanted my husband to be in charge of my financial matters I would have to do an enduring power of attorney with his name and if I wanted him in charge of my health care and personal decisions I'd have to fill in a personal directive with his name as my agent so he'd have to be written in two separate documents to be able to make those two different types of decisions okay really important to know about a personal directive writing a personal directive does not automatically mean that you are no longer in charge of your personal and medical decisions we find when we educate the public sometimes that's a deterrent people are afraid to write a personal directive because then they think that they lose their decision-making power that is not the case if you write at your personal directive it only comes into effect if it's been proven that you're unable to make your own personal or health care decisions and that requires very specific assessments and documentation to be done in part by a physician so it's not automatic there's a process in place to activate or turn on your personal directive so a couple things that a personal directive before we get into walking you through how to write one yourself you are able to write your personal directive without a lawyer I'm often times if you go to lawyer to say get a will son lawyers were often do a will an enduring power of attorney and a personal directive all at the same time they combine them so if you've gone to a lawyer in the past and had a will done you might actually have a personal directive completed already but if you don't a personal directive can be done either with a lawyer or without a lawyer it's completely up to you so with your personal directive once you write it it's really important to keep the original in a safe place because you don't want anything to happen to it but it's really important to make sure that there's copies out there you want to make sure that your agent has a copy that your family or your loved ones have a copy it's a good idea for your health care providers or your doctor to have one and it's a good idea to have one in your green sleeve if you have a green sleeve okay because your personal directive is not going to be very helpful if nobody can access it so now we're going to go into writing your own personal directive and kind of walking you through what you can read in it so getting started it's really important to know that in Alberta there is no standard format for a personal directive so they can look many different ways they can look like a standard legal typed up legal document they can be handwritten on a piece of paper or they can be written on a variety of different templates that exist out there as long as it's signed and dated and witnessed it is a legal personal directive that's valid and that should be honored even if it comes from another province or another country or even if it's titled something different as long as it's signed dated and witnessed we should be honoring it well you might find in Alberta Health Services we tend to use and provide the personal directive template that's been developed by the office of the Public Guardian it's a really nice personal directive template because it has an instruction sheet and it's broken down section by section so it really walks people through what each section means and what you should be including in that section so that's why we've elected to use it so in Greensleeves and Alberta Health Services there's a blank template from the office of the Public Guardian which is like I said quite user friendly so that being said it's always important to make sure you check your documents if you are wanting to write a new personal directive take a look is it like I said if you've had a wheel done before go take a look if there's a personal directive in there if you're still happy with what it says there's no need to redo it on this office of the Public Guardian template or any standard form so any personal directive has four key elements so there's a revocation of previous personal directive statement it's where you can designate your agent there's a section about designating your agent there's a section where you can write health care wishes and then there's the witnesses and signatures which makes your personal directive legal and valid so revocation of previous directive so whether you're using a template whether you've gone to a lawyer or whether you're hand writing your own personal directive just even on a blank piece of paper either automatically there will be a statement included or you need to write one some sort of statement saying that you revoke any other previous personal directives that you have written it's really important to do this because writing a more current personal directive doesn't automatically void a previous one okay the rule of the most current trumping all others does not apply here so it's actually possible to have two personal directives in effect if you don't write a specific statement saying avoid all other ones so really really important to be doing that and if ever in future you want to make a change to your personal directive maybe you want to change your agent maybe your healthcare values have changed if you're just not happy with it it's always good to write a new personal directive void put that statement in there voiding all others rather than editing a pre-existing personal directive because if it ever gets called into court it just looks like it's been tampered with so it's always best just to do a fresh one rather than trying to edit a previously written personal directive the next key element is designation of agent or agents so your agent really can be anybody you want okay they do need to be at least 18 years old and they do need to have capacity because if they don't have capacity to make their own decisions they can't making decisions for you but what you really want to be thinking about is someone you trust okay your agent does not have to be your spouse does not have to be your partner it doesn't even have to be a family member what's most important is thinking about someone you trust and someone you feel comfortable sharing your wishes with and someone that you're confident will respect your wishes even if they don't agree with them you do want to think about somebody who can be contacted so your agent does not have to live in the same city as you it's ideal if they do because then they're close by if something happens but as long as we can contact your agent they don't have to live close by cellphones have really opened up um you know how easily we can contact people so as long as we can contact your agent they don't have to be living close by you want to think about somebody who can communicate well and somebody who's not gonna fall apart under a stressful situation because if they're ever called in to make decisions on your behalf it's really hard and it's most likely not in the best in the best circumstances so you want to think about somebody who's gonna be able to think clearly even when they're under stress now you can have multiple agents which is actually a really good idea but you need to be aware that how you write the names really matters because we're dealing with a legal document here so if I had my two friends or my two kids or whatever if I wanted both of them to be my agent if I wrote Mary Smith and Bob Jones by using the word and it means that both Mary and Bob have to be agreeing on every single decision that they make for me they both have equal decision-making power so if they don't agree it can be a real impasse into a decision being made so oftentimes we do hear that people especially if you know some of our our elderly population are seniors you know they might want all of their children to be their agent so they might have Mary Ann Smith or Mary Ann Bob and Steve and David but we tend to discourage people from doing this because the likelihood of everybody agreeing every step of the way this is not it's not great and it can really become a problem if if agents can't agree so your other option could be if I wrote Mary Smith or Bob Jones so the word or means I'm happy with Mary making its decision or Bob it doesn't matter who so if I'm in the hospital and Mary's there one day if a decision needs to be made Mary can go ahead and make it maybe the next week Bob happens to be there same thing Bob can make that decision as well so either-or I'd be happy with either of them the third option which is probably probably the the best is putting Mary Smith and then putting primary so and then Bob would be the alternate so this gives a little bit of a ranking order so by writing it this way it means that Mary is my top choice I want you to go to Mary first but if something happens where maybe you can't get ahold of Mary or maybe Mary falls apart and she's can't make decisions or she refuses for some reason then I want you to go to Bob and then if I had a you know a second alternate and a third alternate it's just that ranking system so that health care providers know who to start with and who to go to next so a couple other things about your agent is again like I mentioned your agent should have a copy of your personal directive because they need to know what's in it especially if you've written any healthcare wishes and they also need to be able to prove that they that that they do have legal authority to be making decisions on your behalf they should know where the original is it's unlikely that they would need to produce it but if there was ever a question about a personal directive being tampered with then they might need to be able to produce the original to make sure that that isn't the case your agent should know that you have picked them and they should agree you don't want this to be a surprise because your agent can say no there is no law stating that somebody has to be an agent just because you write them down and your personal directive so really important to make sure you ask your agent and you let them know that you've chosen them and written them in your personal directive and your agent also should know that they are legally obligated to follow your wishes if they're speaking for you so by signing up to be an agent there are some legal obligations involved as well so some other legal obligations I mean if if your agent is in a position where they need to be speaking for you they do need to provide the personal directive to the healthcare team they're the ones who are involved with you know in discussions with physicians with the health care team about your medical care maybe or about placement where you live who can visit you they're involved in all all of those discussions they should be including you as much as you are able in decision making so just because they're your agent and they're now making decisions doesn't mean that they should just be cutting you out of the picture completely they should be including you in decisions as much as possible they should also be keeping a written record of all decisions which is really important for agents to be aware of they're also legally obligated to be making decisions based on any wishes that they're aware of whether they're written or Express new conversations that they had with you previously and if they don't know any wishes they're always legally obligated to be making decisions in your best interest which means making decisions thinking about well what would you do not what do I want to do what would you do and as healthcare providers or even in your in your personal life if you're ever concerned about an agent if you feel like they're not acting in the in someone's best interest they're not doing a good job you can't contact them when you need there's a neglect there's abuse anything like that you can put in a complaint with the office of the Public Guardian and trustee and they'll start an investigation so on your screen there's the link there's a form that you would fill in you do have to provide your name but when the investigation is started it would be kept confidential so if you did complain about an agent they would never know that it was you who launched the complaint so now we're gonna move on to healthcare wishes so in a personal directive it's a great place to be writing some healthcare wishes that legally should be followed if applicable to what's happening okay if you've written healthcare wishes that make no sense to what's going on or have no bearing on decisions that need to be made they're not going to be followed but if they're applicable to what's happening that's when they should really be informing care but oftentimes people struggle with well what do I write what kind of things should I write for health care wishes and what we recommend is writing kind of value statements or quality of life statements oftentimes personal directives will have statements that are very intervention focused you know like no heroics I don't want CPR no tubes no machine and that can be helpful in some context but often times it doesn't apply to the the wide range of decisions that an agent might have to make for us so we we really do recommend kind of writing broader quality of life statements that help your agent in a wider range of situations so thinking about things like you know what's most important in your life what what do you need to have in your life to give you joy and meaning what does quality of life mean to you what does no quality of life look like for you are there certain things that you could not live without you know is it is it being able to walk is it being able to eat is it being able to communicate with your loved ones and are there any situations where you would not want your life prolonged and like what does that look like so those sorts of statements that's really the type of information that your agent would need to be able to make good decisions for you that being said there is reason for you in certain situations for a personal directive to be a little bit more specific so for example if you have a health condition you know maybe like dementia like cancer where there's there's a known trajectory or a known pathway for how this disease will progress then maybe you'll have a little bit more specific information and instructions about decisions that most likely will have to come up so for example if I was diagnosed with dementia you know I might say when I'm at a point where I no longer recognize my family I didn't no longer eat anymore I'm bedridden at that point I would not want you to prolong my life so again that might be a little bit more specific to what decisions I know will probably be coming down the road so a couple of special considerations these are questions that we get a lot when we're out educating the public what about medical assistance in dying and organ donation actually comes up a lot these are definitely related to advanced care planning but they're also a little bit separate as well so as of right now medical assistance in dying the law in Alberta states that we have to be competent and capable to request it for ourselves and if you remember I said earlier your personal directive only comes into play after you've lost capacity so if we're going by your personal directive and your agent is speaking for you that means that you don't have capacity to request medical assistance and dining for yourself so if you were to have written that in your personal directive you know I want medical assistance in dying your agent cannot request it on your behalf because you have to be able to request it for yourself by law so that being said though it is still good information to include in your personal directive because it does give good insight into your healthcare wishes and values so for example if you had said you know if I have dementia and I can no longer recognize my family I would want medical assistance in dying even though your agent could not request that on your behalf that's still pretty good insight and your agent would probably be able to pull from that well maybe we shouldn't be resuscitating or maybe we should be focusing more on comfort so again it still gives good insight into your healthcare values even though your agent cannot request medical assistance in dying on your behalf now organ donation is another interesting consideration so organ donation those processes don't really begin until after you've died so once you pass away the personal directive becomes irrelevant because you've passed away now we're looking at your will so organ donation ultimately comes down to your family being willing to sign the consent forms to allow harvesting procedures to begin and so again it's a great thing to write in your personal directive because if your agent and those close to you are aware that being an organ donor was important to you and it's really important for them to know but putting it in your personal directive does not make it legally binding and it doesn't force your agent or family legally to honor it so again it's important for them to be aware but if they're not willing to sign the consent forms after you've passed away it's not gonna happen so witnesses and signatures this is the other mandatory component of a personal directive so again your personal directive isn't considered legal or valid until it is signed dated and witnessed so your witness is it can really be anybody it doesn't have to be a lawyer it doesn't have to be notarized you can have a neighbor a friend really anybody can witness for you they have to be at least 18 years old and what they should be doing is if you're using a template where just initialing throughout the directive they should initial everywhere you have initials then they need to watch you sign and date the personal directive and then they need to sign and date the personal directive in front of you and basically what your witness is saying is you are who you say you are and you're not doing this under any duress now there are a few people who cannot witness so anyone you have listed as an agent and your personal directive cannot be a witness the spouse or partner of anyone you've listed as an agent they cannot witness and your spouse or your partner they cannot witness either and it just comes down to kind of conflict of interest or the perception of potential conflict of interest now as a health care provider as an LPN are you able to witness a personal directive for a patient or a client and if if you are physically transcribing or writing a personal directive on behalf of someone who's not able to physically write it themselves then no you would not be able to witness it but otherwise yes so it is fine but it's just important to be aware that if you're witnessing a personal directive in a healthcare provider capacity you're held to a slightly higher standard so if someone's personal directive was challenged and it went to court you'd be responsible to really kind of account for the fact that this person knew what they were doing they understood the documents so just about that that slightly higher element it's it's a degree higher than just saying well it this person was who they say who they said they were okay so that being said if you ever want to witness a person's personal directive there's no other option you can do it but just make sure you document really well something to the effect that you know this person understood the document they understood the choices they were making so just really trying to protect yourself through documentation um so now that's the end of my portion so hopefully I've given you the tools to kind of think about your own personal directive in and write one if you haven't already now I'm gonna pass it over to Alexandra and she's gonna drill down what you need to know about personal directives when you're working in your LPN role so thank you Jennifer so I'm just going to go through what's important as your role as a licensed practitioners what you're looking for in terms of a personal directive how to tell if a personal directive is activated and how the activation of the personal directive impacts your practice and what your role is in activating a patient's personal directive so like Jennifer said before there is no standard form for a personal directive so which makes our lives kind of difficult as a professional because it can be written it can be typed it can look like a legal document it can look like a piece of paper it can be handwritten but as long as it's signed dated and witness it's a legal document so it can even be called something else it may be in some places called an advance care directive even if it's coming from another province as long as it's signed dated and witness it's a legal form for Alberta the personal directive Act is specifies that in the personal directive we can appoint someone to help in terms of deciding whether we have lost capacity or not so when that happens how the personal directive is activated is different than if that's not stated so they're very specific in the personal directive Act in terms of what's documentation you use so if in the personal directive it's states that your friend or your spouse or your maybe your agent is supposed to determine your capacity then that person would fill out a schedule - along with the physician or psychologist and these are very specific forms we have them on the screen here for you as scheduled - so that would be if you named somebody in your personal directive to determine your capacity always along with a physician or psychologist if you left that part out then it would default to a Schedule three so then it would be a physician or a psychologist would determine your capacity to enact the personal directive along with another service provider if the personal directive stated that it needed to be to physicians then that's what would be happening and it would be a Schedule three so remember the schedule - it gets completed for first by the person listed in the PD and then the part two gets completed by the physician or the psychologist when we're filling out the Schedule three it's to be used when no one is listed or when two physicians are listed so it would be completed by the physician in psychologist part one and then part two could be completed by another service provider the service provider is defined under the personal directive Act and it includes licensed practical nurses so what we need to look at is there a completed schedule two or three to determine if that person's personal directive is activated and we are only looking for that schedule two or three it cannot be activated on a piece of paper from a physician or a letter from a physician it has to be on those specific schedule twos or three so when a personal directive is activated by law the agent makes all the personal decisions so then we're going to the agent to ask them for consent we're asking them to sign any paperwork we wouldn't be going to the patient or the client the agent has responsibilities Jennifer talked about a little bit they must know follow any of the healthcare wishes and instructions that are in that personal directive if they apply to the situation and also as health care providers we are also to follow the wishes instructions written in the personal directive so when we have a personal directive the sometimes in a personal directive a person puts in there I don't want to be resuscitated I don't want to have CPR but we can't just follow that so remember if something's in a personal directive that needs to be a medical order we still need that medical order so somebody writes in the personal directive please do not resuscitate me you should be telling them to go to their physician because that form needs to be filled out before we can actually follow it so personal directives as your wishes and values which we can follow up on but we still need that medical order we have a nice algorithm here for you to understand and have a look at what to do if a person's personal directive is activated or not activated so if it is activated we're looking for that schedule two or three and then we're identifying the agent and making sure that the age it makes the decisions if it's not activated then we're looking to see is the patient competent then the patient makes their own decisions but if the patient is not competent then we need to determine if it's the right time to activate the personal directive so for your CLP a guidance the LPN can perform a capacity assessment for the purpose of enacting a personal directive that means that you are allowed to complete part two of the Schedule three document but just because you're allowed to we're caution you to make sure that you're well familiar with the documents and that you know exactly why you're filling out those documents and a little thought is would it stand up in court so if you were brought into court would you be able to defend that application or that documentation that you filled out so if you're feeling that you're not comfortable filling out that documentation you can certainly say no I don't feel comfortable doing it and you don't need to do it but an LPN cannot perform a capacity assessment when a patient does not have a PD and you're doing an application for guardian or trusteeship it's a whole different document and those capacity Assessors do need some documentation that they are qualified to be capacity Assessors so in terms of resources we have the personal directive Act if you ever want to look at what it says some of the definitions but we also have great guides understanding personal directive is a great one to start with it goes through all the things that you need to know when you're filling out a personal directive and some of the laws that go along with it if you're feeling that you want to do the capacity assessment under personal directive Act the next guide is a great resource it walks you through step by step in terms of how you would do that your own licensing board the college of license nurses also have their own guidelines which you can also follow so why is events care planning so important it's when we found did some studies we found 60% of Albertans have discussed what their treatment wishes are what they want with their family but only 20% of Albertans are actually talking to us so we're not doing a great job of engaging people and having them talk to us about what their wishes are so a great place to start is to remember those five steps and if you've done those five steps for yourself it's a lot easier to talk to your clients and patients about those steps explain what advanced care planning is and why it's so important for all of us ask them if they have a personal directive explain what one is and you can always tell them I have my own personal directive and this is what I put in mind and they'd also remind them that is for everyone over the age of 18 it's not because somebody has an illness it's not because somebody is the senior so in terms of what can you do to start that conversation like I said before some really simple questions do you have a personal directive do you have a decision-maker and do they know what you would want very easy questions to start their conversation you can also give out our conversations matter booklet which walks people step-by-step through in terms of those five steps it's a really easy booklet to read we just encourage you if you're giving resources to your patients please open the resources point to different aspects in the booklet a point to the checklist at the end so that they'll actually use that booklet as opposed to recycling it so one of our main gems are is that advanced care planning and personal directives are actually the forefront and the beginning of patient centered care it directly impacts about if we know what our patient wants it's important that you know if your patient has an activated personal directive are you going to the agent for consent or are you talking to the patient themselves and do you know who that agent is so going through that advanced your planning process and writing your own personal directive makes this process so much easier you'll understand when you see a personal directive you'll understand the importance of it because if you went through the trouble of going through a personal directive making one assigning an agent putting in what your healthcare wishes once you want it to be activated when it was necessary and once you want the healthcare providers and the agents following what your wishes and values are if you want more information we have a website conversations matter they've got information there for health professionals and patients and Families so as a health professional you can do our Iman jewel you can access the videos you can also order any kind of resources you need or supplies whether you're in Alberta health or out Alberta health these are some of our references you can go through them most of our information comes from the office of the Public Guardian and you can visit their website and where they have more information on personal directives all of the images have been cited and we have permission for them to be used if you want more information or wanting some of the documents that we've listed in our session today please contact the College of licensed practical nurses of Alberta the emails are listed if you have other questions they will certainly directly contact us we'd like to thank you for joining us today and if you have any further questions please call contact the College thank you for joining