Page 47 - Encyclopedia of Nursing Research

14 n ADvANCE DiRECTivES

the Missouri Supreme Court standard that care issues with their health care provider at
required clear and convincing evidence of their office visit during a time that they are
A the patient’s wishes before permitting the less anxious. Literature on end-of-life care
family of Cruzan to discontinue the tube reveals that patients and health care profes-
feedings that were sustaining her life. sionals, including physicians, nurses, and
The U.S. government through the social workers, tend to avoid discussing
Congress and Supreme Court has demon- decisions about preparing for end-of-life care
strated interest in assuring the public is (Rizzo et al., 2010). The Study to Understand
aware of the benefits of advance directives. the Prognoses and Preferences for outcomes
in 1991, the U.S. House of Representatives and Risks of Treatment (SUPPoRT Principle
enacted the Patient Self Determination Act. investigators, 1995) involved 4,805 patients
This federal legislation validates the exis- in five teaching hospitals who were at an
tence of advance directives in each state and advance stage of illness. The study found
stipulates that all hospitals who received that physicians often ignored advance direc-
Medicare or Medicaid reimbursement must tives regardless of efforts made to improved
assure that patients have or would like to physician to patient communication regard-
have advance directives. Hospitals must ing end-of-life decisions.
offer assistance to patients in completing a There are limited studies that focus on
directive upon patient request. the effect and knowledge that nurses have
Although an individual may have regarding advance directives. Crego and
advance directives, there are situations in Lipp (1998) found that more than 50% of the
which they may not be complied with. Many nurses of the 339 nurses that were surveyed in
times, advance directives are not available a 600-bed acute hospital did not have a good
when they are needed because of the patient understanding of advance directives. Sixty-
not letting their loved ones know of the exis- seven percent thought that the nurse was the
tence of such a document or a hospital may most likely health care provider to assess the
fail to include a copy of the patients specific need for advance health care planning. Wood
advance directives in his or her medical and DelPapa (1996) conducted a small survey
chart. The interpretation of the terms within of hospital nurses (n = 112) and found that
an advance directive document can cause 76% of nurses had a low level of knowledge
debate, and a clearly written document may on questions related to advance directives.
also not represent a patient’s wishes as the A study by Scherer, Jezewski, Graves, Wu,
reality of their own death becomes immi- and Bu (2006) assessed 210 certified critical
nent. Health care proxies can have a difficult care nurses regarding their knowledge and
time following making decisions regarding experience regarding advance directives.
life-sustaining interventions because of their Results demonstrated that 94.8% of the crit-
own feelings and beliefs about death and ical care nurses felt that the nurse’s primary
their connection and relationship with the responsibility was to ensure that the patient’s
patient. decisions were met, 42.5% agreed that the
Further studies have demonstrated that a information available on advance directives
lack of advance care planning leads to issues, was sufficient to direct treatment, and 6%
questions, and concerns regarding end- had low knowledge scores on questions sur-
of-life care (Lawrence, 2010). Adults should be rounding advance directives.
encouraged to complete their advance direc- The role that advance directives play in
tives when discussing medical decisions with end-of-life care decision making will con-
their health care providers. Stetler, Elliott, tinue to be a topic of ongoing discussion and
and Bruno (1992) found that 60% to 80% of debate. This controversial discussion will
patients would like to discuss end-of-life continue to have an emotional impact on all