ABSTRACT
The Patient Self-determination Act requires that patients be informed in writing of their right to accept or refuse treatment and the right to an advance directive. For the past 15 years, hospitals have been providing these written materials, yet advance directives are still not adequately directing end-of-life care. Barriers and facilitators to implementation of this law are discussed, as well as the role of nursing management in meeting its true intent.
Subject(s)
Advance Care Planning/organization & administration , Informed Consent/legislation & jurisprudence , Patient Rights/legislation & jurisprudence , Patient Self-Determination Act/organization & administration , Advance Care Planning/ethics , Attitude of Health Personnel , Attitude to Health , Cultural Characteristics , Health Knowledge, Attitudes, Practice , Health Services Needs and Demand , Humans , Informed Consent/ethics , Informed Consent/psychology , Medicaid/legislation & jurisprudence , Medicare/legislation & jurisprudence , Nurse's Role , Organizational Innovation , Patient Rights/ethics , Patient Self-Determination Act/ethics , Religion , Socioeconomic Factors , Treatment Refusal/legislation & jurisprudence , United States , Western WorldABSTRACT
The amount of didactic content on advance directives in nursing curricula is addressed. Conclusions have relevance to the limited knowledge of practicing nurses on the subject of advance directives.
Subject(s)
Advance Directives , Curriculum , Education, Nursing, Associate/organization & administration , Education, Nursing, Baccalaureate/organization & administration , Education, Nursing, Diploma Programs/organization & administration , Advance Directives/legislation & jurisprudence , Analysis of Variance , Humans , Models, Educational , Needs Assessment , North Carolina , Nursing Education Research , Patient Self-Determination Act/organization & administration , Program Evaluation , Students, Nursing , Surveys and Questionnaires , Teaching Materials , United StatesSubject(s)
Advance Care Planning/organization & administration , Advance Directive Adherence/organization & administration , Quality of Health Care/organization & administration , Aged , Geriatrics/organization & administration , Health Services Research/organization & administration , Humans , Nursing Homes/organization & administration , Outcome Assessment, Health Care/organization & administration , Patient Self-Determination Act/organization & administration , United StatesABSTRACT
Attention to culturally specific rituals germane to end-of-life rituals are important for the nurse who is delivering culturally competent care. The Patient Self-Determination Act implemented in the United States in 1991 brought with it some specific assumptions of values related to end-of-life care involving patient autonomy, informed decision making, truth telling and control over the dying process (USC, 1990). The assumptions and values assumed in this act are not necessarily shared by persons in the United States who are from a minority culture, particularly one other than White of European descent. This manuscript considers the values of the Patient Self-Determination Act passed in the United States and specific cultural beliefs which may pose a conflict for the care giver in the delivery of culturally competent care. The Giger and Davdihizar (2004) Transcultural Assessment Model is used as a way to assess patient and the family in an effort to plan culturally appropriate care that recognizes the uniqueness of each individual at the end of life.
