A call to improve practice concerning cultural sensitivity in advance directives: a review of the literature.

BACKGROUND: The Patient Self Determination Act of 1990 mandates healthcare providers (HCP) to speak with patients about end-of-life preferences and advance directives (AD). HCP work with patients of varying cultures, and standard ADs do not address cultural differences. In order to understand various cultural beliefs, cultural sensitivity is important especially when discussing advance care planning (ACP). AIMS: Individuals from differing ethnic backgrounds are likely to turn to their traditional norms of practice when ill or treatment choices must be made. An AD that addresses varying cultural values and beliefs was sought. METHODS: A comprehensive review of the literature was conducted. Articles selected for review included qualitative and quantitative studies. The evidence was evaluated and synthesized for information related to cultural sensitivity and ADs. FINDINGS: Three common themes emerged related to ACP discussions and culture. Healthcare provider awareness, communication, and education concerning cultural differences and ACP assisted in meeting the needs for end-of-life planning in the current era of increased globalization. Education for HCP on cultural differences and how to lead discussions promoted ACP. IMPLICATION FOR PRACTICE: ADs are an essential part of health care and promote patient-centered care. (HCP) should be able to recognize differing cultural values and beliefs in order to initiate conversations about end of life. Initiating conversations about ACP can be facilitated by using open-ended questions that respect the values and beliefs of various cultures.

An innovative approach to peer review for the advanced practice nurse--a focus on critical incidents.

PURPOSE: To provide an overview of the development and implementation of a peer review process for advanced practice nurses (APNs) based on critical incidents that provide meaningful evaluation of practice and meets the needs of APNs across multiple care specialties and practice situations. DATA SOURCES: A review of the literature and evaluation of the existing peer review process currently in place at a large tertiary care facility. CONCLUSIONS: Peer review is central to self-regulation and professional practice for APNs. It has been proposed that APNs of similar rank and clinical expertise should participate in peer review. APN peer review and evaluation have traditionally existed as a component of performance evaluation, evaluation of practice patterns, and compliance monitoring, and to evaluate quality indicators. We found no examples of peer review in the context of evaluating a critical incident in the literature. The APN Peer Review Committee and the review process were developed at our institution to provide peer input and communication to all credentialed APNs in incidents regarding appropriateness of care and scope of practice. IMPLICATIONS FOR PRACTICE: APNs must assure that they have a voice in the peer review process. Representation by peers of similar specialty and rank is an important component in the peer evaluation process. The establishment of the APN Peer Review Committee served this purpose for our institution.