Advanced Care Planning And Advance Directive Completion

A person’s life can end at any age. They can depart quickly or slowly. End of life care, also known as palliative care, is the care of patients that are not only in their final hours or days but the patients with a terminal illness that has become incurable. End of life care takes into mind what the patient desires so it is recommended that they consider an advanced care plan also known as an advance directive and living will. These documents allow the patient to formulate decisions on the future of their care if, at any point, they cannot vocally express themselves.

Death is inevitable. It is one of the only certainties in life. Regardless, people are often uncomfortable discussing death. Nyatanga (2016) posits that the idea of no longer existing increases anxiety and emotional distress in relation to one’s mortality. Because of the difficulty in level of care for end-of-life patients, the patient and the family often need professional assistance for physical and emotional care. Many family caregivers are not professionally trained in medicine, and this is where hospice comes into play. Hospice aims to meet the holistic needs of both the patient and the patient’s family through treatment plans, education, and advocacy. There is a duality of care to the treatment provided by hospice staff in that they do not attempt to separate the patient’s care from the family’s care. Leming and Dickinson (2011) support that hospice, unlike other clinical fields, focuses on the patient and the family together instead of seeing the patient independent of the family. Many times in hospitals, the medical team focuses solely on the goal of returning the patient back to health in order for them to return to their normal lives. They do not take into account the psychological and spiritual components of the patient’s journey and the journey that the family must take as well. For treatment of the patient, Leming and Dickinson agree that hospice does not attempt to cure patients, and instead concentrates solely

A patient barrier might include having limited knowledge surrounding life-support systems and treatment options, thereby hindering their ability to fully comprehend or demand certain interventions. Good counseling is therefore essential to overcoming this barrier in implementing the patient’s true and best wishes (Kroning, 2014, p. 222). Another barrier in implementing advance directives concerns the role and influence of family members and the patient. There may be discordance between the desires of the patient and family, which can result in serious debate and tension if not addressed and taken into consideration. Physicians still may have reservations, as certain demands made by the patient may raise ethical concerns in the future, if the provider feels the interventions being done are no longer medically appropriate.

It is necessary to involve the individual in the plan of care and support. Encourage the individual to make choices. This includes their needs, their culture, their means of communication, their likes and dislikes, wishes and feelings, advance directives, beliefs and values, involvement of their family and other professionals. This should be considered and documented. Also, there must be evaluation in assessing effectiveness in the plan of care.

In this paper, I will discuss advance directives, what it is, and the reason for it. I will talk about the issues that are currently facing advance directives care and talk about whether it has failed, or not. Finally, I will prove my stand on the issues with evidence.

“The Utah State Legislature updated and transformed advance health care directives in Utah during the 2007 legislative session. Effective January 1, 2008, under Senate Bill 75 (second substitute), the Advance Health Care Directive Act replaced the Personal Choice and Living Will Act as the law governing advance health care planning in Utah” (Henry, M., 2007).

Hospice is compassionate care provided to patients facing terminal illness or illness for which there is no cure. These patients are diagnosed with an illness from which they will never recover and usually have a life prognosis of six months or less (Hospice Foundation of America, 2014). The goal of hospice care is improving quality of life and managing the symptoms of disease and the dying process. The care hospice offers is focused on pain management and emotional and spiritual support for both the patient and family (National Hospice and Palliative Care Organization, 2012). Hospice care can be provided in many different settings, often the patient’s own home. Hospice care can also be provided in hospitals, nursing homes, long-term care facilities and free-standing hospice centers and is available to patients of all ages (NHPCO, 2012). A patient receiving care in a hospice program has a team of healthcare individuals that can consist of the patients own physician, nurses, home health aides, clergy, social workers, and speech and physical therapists (NHPCO, 2012). Usually, a care plan is developed by the hospice team and care of the patient is provided by family members with the support of the hospice staff (NHPCO, 2012). Nurses make regular visits to the patient and family and are on call 24/7. Once enrolled in a hospice program hospice covers everything that will be needed to care for you, from medications to manage pain to

Advanced directives have received increasing advocacy over the past 20 years. High profile cases, the Joint Commission on Accreditation of Healthcare Organization (JCAHO) and the Patient Self-Determination Act

PSDA requires that all care facilities receiving Medicaid and/or Medicare funding are required to educate and acknowledge patients advanced directives. PSDA legislation requires implementation of the following: patients are given a mandatory notice of their medical decision rights, the documentation of any advanced

Planning for end of life care for a loved one can be a very difficult process for some families. Knowing that you are going to lose a loved one and planning for how they will be taken care of can be quite stressful. End of life planning can be used in two different scenarios one of which is for terminally ill patients and the other is for the aging and elderly. Planning for end of life care can be quite expensive with all of the doctor visits and counseling’s. In Obama’s Affordable Care Act there is some hope for the elderly for paying for some of these expenses.

“The final moments of one’s life are difficult for everyone involved-the patient, loved ones, and even the healthcare provider” (Klein, 2005). If a patient’s final wishes regarding his/her care are undefined or not clear, then the situation could be worse or uncomfortable. During what should be a time of caring, mourning and supporting one another can quickly become overshadowed by ethical and legal battles. However, this can be prevented and avoided by the execution of advanced directives.

The use of a form of Advance directives dates back as far as 1914, in where case law established the requirement to obtain a patients’ consent for invasive medical procedures, based on the right of self-determination (U.S. Department of Health and Human Services, 2008). It was not until the late 1960’s that Advance directives began to be developed in the United States. Patient and consumer rights movements sought legal measures through state and federal actions to alleviate the use of aggressive and ineffective life-sustaining treatment with the living will, the known as the earliest form of an advance directive (U.S. Department of Health and Human Services, 2008). In 1976, the Natural Death Act in California, “was the first law to give

With an increasing aging population and growing numbers of individuals with chronic conditions, it is important for individuals to prepare for end-of-life care. An Advance Directive is a defined as a “legal document that provides data to critical care staff about patients’ wishes, especially when critical illness decreases decision-making ability” (McAdam, Stotts, Padilla, and Puntillo, 2005). An Advance Directive also allows for better communication between the patient and doctor, and preserves the autonomy of patients. It may also alleviate one’s family from any possible burden of uncertainty of one’s wishes. It provides guidance, which may avert arguments with family members concerning treatment choices (Cedars Sinai, 2015). The Patient

Advance Care Planning (p.568): This concept is talking about a patient who wants to discuss their preferences about end-of-life care and whether or not they would like to receive life-sustaining treatment. I found this concept interesting because the text mentioned a study which said more people were deciding on hospice care rather than life-sustaining treatment. I thought that this was interesting because I would have expected more people that wanted to live longer by the help of medical assistance.

As individuals age changes occur physiologically that are part of normal aging. These changes occur in all organ systems and can impact an individual’s quality of life. The changes related to aging can be attributed to an individual’s genetic make up, lifestyle, physical activity, and dietary lifestyle. Being able to differentiate between normal changes in aging against disease process is important because it can help clinicians develop a plan of care (Boltz, Capezuti, Fulmer, & Zwicker, 2012). Creating an accurate plan of care for older adults will greatly impact their quality of life.