The Patient Self-Determination Act, passed by Congress in 1991, requires hospitals, nursing homes, and other health facilities to provide information about advance directives to patients and to keep a record of any completed documents. An advance directive is a legal document outlining a patient’s preferences for treatment at the end of life. It allows patients to name a person (“agent”) to decide for them if they are unable to decide. As the population of older Americans is increasing, one in five Americans will be over age 65 by 2030 and a life-threatening situation such as cardiac or respiratory arrest can occur at any time. Nurses need to take an active role in educating patients about the different types of advance directives and must talk with their patients and families in terms of their goals of care and preferences for end-of-life care to ensure that patients’ wishes for care at the end of life are known and respected.

Here are three tips to help you integrate them into your daily practice.

1. Review and verify the patient’s advance directive status at his or her first patient contact.

Nurses can help patients explore treatment options and prepare them to participate and discuss with physicians in making the best possible option based on their preferences.

2. Assess the patient’s educational needs.

Patients must be provided with complete information about advance directives and have the opportunity to discuss all of their alternatives and options. Having sufficient knowledge will enable patients to make sound and knowledgeable decisions about their own advance directives. Their education should also include the benefits and risks associated with their choices. It is important for nurses to understand their workplace policy and procedures about advance directives and take any available education about advance directives to increase their knowledge.

3. Advocate for your patients’ decision representing what is best for them.

Nurses have an important role to promote their patients’ decision concerning the treatment or withdrawal of medical care and completion of advance directives. Understanding the options available to the patient can help nurses confidently and purposefully address their patients’ needs. It is imperative that nurses are knowledgeable about their state and federal laws related to end-of-life care and are able to answer the patient’s questions concerning different types of advance directives.

Nuananong Seal & Mary Wiske

Nuananong Seal, PhD, RN, is a nurse researcher and a consultant for health promotion and health prevention research.

Mary Wiske, RN, is a retired community health nurse.

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