Patient Self-Determination Act (PSDA)

The Federal Patient Self-Determination Act (PSDA) of 1991 first brought attention to the importance of advance directives (GAPNA, n.d.). Although regulatory bodies continue to promote advance directives, little has been done to encourage and enforce this initiative, highlighting the need for directed efforts to improve AD completion rates. The overall prevalence of completed advance directives in the United has been estimated that 5-15% (Tung & North, 2009). This indicates a need for programs to educate and empower patients and providers to ensure that dialogue about advanced care planning is initiated early on, and that advance directives are completed. Studies have shown that patients prefer that their primary care doctor initiate such planning while they are in good health and that such planning should occur earlier than it did in terms of age, natural history of disease, and patient-physician relationship. The barriers to advance care planning that have been identified include availability of trained staff, organizational commitment and policy to support advance care planning, and understanding/support of providers (Ramsaroop, Reid, & Adelman, 2007).

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.

Sule stated that, “The Patient Bill of Right adopted by American Hospitals Association states that ‘a patient possesses the right to be informed of the medical consequences of his or her actions and decisions and refuse treatment to the extent permitted by the law’. However, this is true only if the patient is in position to understand the consequences of his treatment. Incompetent, senile patients neither have the correct judgment regarding which treatment is appropriate for them, nor are they in a state of understanding the implications of their treatment. In such case, their willingness to grant or deny consent cannot dictate the course of treatment.” Problem with the Act is being able to find that the patient component enough to make such a call. Another issue that Sule stated was on confidentiality and autonomy. According to Sule, “This is another ethical issue erupting from the conflict of patient's rights and professional ethics in nursing job and profession. The Patient Bill of Right makes it mandatory for the medical practitioners to reveal the form and extent of the ailment along with the course of treatment to be undertaken by the practitioners. However, this law of autonomy clashes with the nursing ethic that the professional should maintain high degree of confidentiality regarding the patient's health and treatment.” This can cause conflicting issues in the NP’s

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.

Hospice crusade in the United States has advanced over the past 25 years. The focus of hospice is comprehensive physical, psychosocial, emotional and spiritual therapy in people, who are terminally ill and their families. Hospice providers are helping the quality of life by whenever they can, instead of hospitals, protecting patients treated at home from the burden and provide intervention. Hospice nurses are mainly in accordance with the 1983 Medicare Benefits Act, guidelines of the federal program that allows the patient to die in their own home with family and friends at their next offer treatment (Nurses for a Healthier Tomorrow, n.d).

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

This film explains the legal role of advance directives in end of life issues. An advance directive is “a written document directing how medical decisions are to be made in the future when the patient lacks decisional capacity and is unable to decide and choose” (Hanlon, End of Life Issues, Slide 28, Bullet 1). All three of the cases demonstrate the importance in filling out some form of directive. When there is nothing to go off of, it makes decisions extremely tough for families and medical providers. Having legal documentation of patient wishes helps understand what treatments they would or would not consent to. In cases like

In the older patient that has planned for end-stage diagnosis, an advance directive provides a means to articulate patient requests. However, in the patient who has sustained

Since in the mid-seventies the health advance directives has become the central legal document to make sure that one’s health care wishes is known in a formal corrected way and it is much an open question. Medical technology can entity continually the vital functions of some people that are terminally ill or who be living in a determined vegetative state. Legislation has been accomplish in the District of Columbia and all states other than Pennsylvania to admit efficient persons to express decision around their treatment in the development that they become unable incompetent and terminally ill and cannot engage in decisions concerning their care.

There is a patient here with a life threating disease that is life threating and this same patient has a DNR in her medical file prohibiting CPR if she were to require it. The next day the patient tells the medical assistant that if she stops breathing please help her breathe again, giving a verbal void of the existing DNR. The MA has to ask herself two very important questions, do I administer CPR or should not administer CPR because she has a DNR order? It wasn’t too long ago that I ask myself these very same questions. Do I want to see my father the way he is or do I take this chance and say my goodbye and remember every day the memories and how much of a role model he was to me. I was the only one in my family who did try to fight to have

The decision to take on such a topic such as advanced directives was not an easy one. The DNP student did not know if the community of healthcare providers would be receptive in participating in such a program. The DNP student has been embedded in the Haitian culture to know that there is an existing issue in discussing of end-of-life care in the Haitian community.

Although my family has trouble talking about advanced care planning, I have felt strongly about this topic ever since I became interested in health care. I feel that its so important for everyone to have their wishes, at the very least, verbalized to their loved ones. I feel that planning for end of life when you are in an unaltered mental state/physical state is pertinent to having the most accurate wishes expressed! I have verbally expressed my wishes, however I feel that I will soon have mine expressed in a concrete way, such as an Advanced Directive form. I wasn’t explicitly educated on this topic until I took my Bioethics course during my sophomore year here at Mount Saint Mary’s. I immediately went home and told my mom about how passionate

According to Pozgar (2016), “The Patient Self-Determination Act of 1990 (PSDA) describes the rights of patients to make their own health care decisions” (p. 438). Indeed, health care organizations need to educate their patients about their rights and make sure that they understand and are aware of them. The PSDA requires hospitals, hospice programs,

Healthcare risk management ( HRM) began in The late 1970s, when hospitals are facing a malpractice crisis (Kavaler & Alexander, 2014). According to Kavaler and Alexander (2014), it is estimated more than 140,000 Americans die from medical errors and the cost ranges between $17 billion and $29 billion each year in the United States (Kavaler & Alexander, 2014). In this essay, the student will explain a healthcare risk management program, evaluate the program for compliance with the American Society for Healthcare Risk Management (ASHRM), and Examine the administrative process of management the risk program.

The study of Wiener et al, further discussed the advance directive document “Five Wishes,” and how it can assist in outlining the plan of care of the patient. It is a document that assigns a legal health care decision maker at the end of life and identifies preferred medical and care treatments. The document is organized into five “wishes” that compose different parts of the end of life care process such as, who the patient wants to make care decisions when they can’t, the type of treatment the patient wants, the comfort level, how the patient wants to be treated, and what the patient wants their loved ones to know. This document allows patients to become involved and informed about their treatment. By offering this option it allows the patient to choose the better treatment option based on their necessities. A developmentally appropriate advance care planning document can play an important role in the care of seriously ill adolescents and children. As nurses, we should be able to listen to the concerns and provide guidance to patients throughout treatment,