Field Activity Paper
The Advance Health Care Directive
Locate a copy of an advanced directive (AD) that complies with the laws of the state in which you work. The organization in which you work should have a copy of an advance directive that is given to patients. If not, download your state’s Advance Directives here http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3289.
Complete the advance directive for yourself. Do not turn in your AD with your paper. The AD is for your personal use.
In your paper, Part I:
- Identify where you obtained the AD and explain its compliance with state law.
- Conduct research (1-2 sources) to learn more about the AD in your state and explain how it works.
- Discuss how easy or difficult it was to complete the AD. Your comments should be specific and both objective and For example, when you state your personal feelings, you must relate them to the literature (textbook and research) that discusses this process and the difficulties that many people face when completing an advance directive.
(Cite/ reference any sources you use to explore these questions, including your texts.)
Physician Orders for Life-Sustaining Treatment (POLST) Form
- What is a Physician Orders for Life-Sustaining Treatment (POLST) form?
- When should this form be completed?
- Who can complete the form?
- Who needs to sign the form to make it a legal document?
(Cite/reference any sources you use to explore these questions, including your texts.)
Tie the two first sections together by writing a summary and conclusion.
This section should address:
- the differences between an Advance Health CareDirective and the POLST,
- the RN’s important role in assuring the patient’s right to autonomy in choosing the healthcareinterventions the patientdoes or does not want.
Use current APA format.
The paper should be between 3 pages in length excluding the title and reference page(s).
Cite and reference the course text and at least two (2) additional appropriate professional sources.
Review the rubric for further information on how your assignment will be graded.
Advanced Care Planning
Q1. Identify where you obtained the AD and explain its compliance with state law
I obtained the Advanced Directive (AD) from the caringinfo.org website where individuals download ADs for either personal as well as family benefit. The link for the AD is http://www.caringinfo.org/files/public/ad/Florida.pdf. The copy has all the elements outlined by the state. For instance, the state recommends that the copy should have a surrogate who will make important decisions about an individual’s medical care including long-life decisions. The other requirement is that one should highlight their wishes in the event that they are in the vegetative state. Then, the copy should also have a section where the person giving the advanced directive and his/her witness should sign for it to be considered as valid. All these elements are present in the copy provided, and therefore, it can be established that the copy is in line with the states’ requirements.
Q2. Conduct research (1-2 sources) to learn more about the AD in your state and explain how it works.
The state of Florida outlines that every competent adult has the right to make decisions about their own health. This includes the right to choose or refuse medical care. However, there are instance where an individual cannot make decisions as a result of either mental or physical illnesses such as Alzheimer’s disease or when one is in a coma (Gaster, Larson, & Curtis, 2017). When one is in such a state, he/she is said to be incapacitated and it is only a qualified health care provider who establish if one is incapacitated or not. To ensure that the decisions of incapacitated individuals on advanced care are respected, the Florida legislature has a legislation, chapter 765, Florida Statutes that guide on what should be done. The law recognizes the right of every competent adult to instruct his/her advanced care physician to provide, withdraw, or withhold life-long procedures. The person can also designate someone else to make treatment decisions if they are unable to make decisions. The enactment also points out that one does not have be necessarily incapacitated to choose a surrogate.
With regards to hospitals, the law states that nursing homes, hospitals, hospices, home health agencies as well as health maintenance organizations (HMOs) should provide patients with written information such as pamphlet to educate them about advanced care. The legislations that provide these directions are 59A-8.0245, 59A-3.254, 59A-12.013, 58A-2.0232, and 59A-4.106, Florida Administrative Code (FloridaHealthfinder.gov, n.d).
Q3. Discuss how easy or difficult it was to complete the AD.
Gilissen et al. (2017) point out that decisions on advanced care planning often trigger strong and sometimes fearful emotions. However, it is important to note that taking this bold and proactive step aids in providing clarity, especially when an individual encounters medical crisis when stress and emotions are running high not only to the family but also to the clinicians providing end-of-life care to the patient.
Personally, I must confess that I had a number of challenges while completing the AD. Completing the form itself was not easy because the decisions I was supposed to make were complex and serious. I was not ready or equipped to decide between aggressive life-sustaining treatment and comfort care, that is relieving suffering without treating the disease. Gaster, Larson and Curtis (2017) argue that when people make daily decisions such as choosing a flavor of an ice-cream, the decision can be based on past experience, however, this is not true when it comes to end of life decision-making. I also felt that the copy was not informative enough to guide me on making decisions for proxies and physicians.
1. What is a Physician Orders for Life-Sustaining Treatment (POLST) form?
A POLST is a physician’s order which outlines an end of care plan by reflecting at the preferences of both the physician’s judgement in accordance to medical evaluation and patient’s preferences regarding end of life care.
2. When should this form be completed?
POLSTs should be considered strongly for patients for who death is likely to occur in the next 12 months. This includes those with end-stage organ failure, metastatic cancers, those with terminal diagnosis, those that currently have or have had DNAR status in the past as well as those receiving either palliative or hospice care (Hazley, DNP Student, & Steinberg, 2017). In addition, a POLST can also be indicated for patients that are residing permanently in long-term care facilities.
- Who can complete the form?
The form can be completed by a patient’s physician or by anyone who has enough training on POLST and has been working closely with the patient’s physician. While completing, the physician should have a thorough conversation with the patient about the current status of the patient and the future medical conditions and preferences.
- Who needs to sign the form to make it a legal document?
The POLST should be signed by both the patient and physician. If the patient is not in a position to make clear medical decisions, the patient’s legally recognized surrogate can take part in completing the form and signing it.
An Advance Health Care Directive is a legal document whereby an individual outlines the actions that should be carried out for their health if they cannot make decisions for themselves due to illness or incapacitation (Sudore et al., 2017). Conversely, a POLST is an order by a physician that indicates the end of life care plan outline, the patient’s preference, and physician’s judgement.
The RN plays an important role in promoting patient’s autonomy during decision-making (Molina‐Mula et al., 2018). The nurse should involve the patient in making the decisions and respect the patient’s choices. The nurse should also provide the patient with all necessary details so that he/she can make an informed decision.
FloridaHealthfinder.gov. (n.d.). Health Care Advance Directives. Retrieved from: http://www.floridahealthfinder.gov/reports-guides/advance-directives.aspx
Gaster, B., Larson, E. B., & Curtis, J. R. (2017). Advance directives for dementia: meeting a unique challenge. JAMA, 318(22), 2175-2176.
Gilissen, J., Pivodic, L., Smets, T., Gastmans, C., Vander Stichele, R., Deliens, L., & Van den Block, L. (2017). Preconditions for successful advance care planning in nursing homes: A systematic review. International journal of nursing studies, 66, 47-59.
Hazley, B. S. N., DNP Student, R., & Steinberg, M. D. (2017). Physician Orders for Life-Sustaining Treatment (POLST) Utilization in a Skilled Nursing Facility: An Educational Quality Initiative.
Molina‐Mula, J., Peter, E., Gallo‐Estrada, J., & Perelló‐Campaner, C. (2018). Instrumentalisation of the health system: An examination of the impact on nursing practice and patient autonomy. Nursing inquiry, 25(1), e12201.
Sudore, R. L., Lum, H. D., You, J. J., Hanson, L. C., Meier, D. E., Pantilat, S. Z., & Kutner, J. S. (2017). Defining advance care planning for adults: a consensus definition from a multidisciplinary Delphi panel. Journal of pain and symptom management, 53(5), 821-832.