Advance Directives Video Presentation Paper
Complete all of the required reading/learning activities for Module B regarding advance directives.
Step II – Conduct a literature search for at least three peer-reviewed articles related to advance directives (and include those on your Reference List).
Step III – Download the Directive to Physicians and Family or Surrogates AND Medical Power of Attorney from https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/nursing-facilities/quality-monitoring-program/evidence-based-best-practices/advance-care-planning
Links to an external site. Advance Directives Video Presentation Paper
Step IV – Prepare at least 5 questions to ask your interviewees (two registered nurses) about their knowledge, education, training, and/or experience with advance directives.
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Step V – Separately interview two registered nurses who are comfortable talking about advance directives (in order to protect your interviewees’ privacy and prevent them from possibility influencing each other, do not conduct joint interviews, and do not record the interviews). During each interview, assess the interviewee’s knowledge, education, training, and/or experience with advance directives by asking them the questions you prepared for the interview. Review the Directive to Physicians and Family or Surrogates and Medical Power of Attorney forms with each interviewee. If you conduct the interview over the phone, be sure to email the forms to each nurse before the interview.
Step VI – Summarize your literature search and interviews in a 4- to 6-minute long video presentation (video only, no powerpoint slides) and submit it here via VoiceThread. Dress and speak professionally as if you were making a presentation about advance directives to colleagues in a traditional classroom setting or conference. Introduce yourself but please do not identify your interviewees by full name in order to protect their privacy.
Step VII – Submit a Reference List in 7th edition APA format with at least three peer-reviewed articles related to advance directives AND THREE of the assigned reading/learning activities about advance directives from Module B. Advance Directives Video Presentation Paper
ASSIGNED READING/LEARNING
- Hellerman, C., Morris, J., & Smith, M. (2014). Brain-dead Texas woman taken off ventilator. http://www.cnn.com/2014/01/26/health/texas-pregnant-brain-dead-woman/
- http://www.cnn.com/2014/01/26/health/texas-pregnant-brain-dead-woman/
- Mar, J. (2017). How do you want to die? Write it down. https://www.kalw.org/show/crosscurrents/2017-01-24/how-do-you-want-to-die-write-it-down
- https://www.nia.nih.gov/health/advance-care-planning-advance-directives-health-care
- National Council of State Boards of Nursing. (2018). A nurse’s guide to professional boundaries. https://www.ncsbn.org/public-files/ProfessionalBoundaries_Complete.pdf
- Texas Board of Nursing. (2021). Position statement 15.29: Professional boundaries including uses of social media by nurses. https://www.bon.texas.gov/practice_bon_position_statements_content.asp.html#15.29
Five interviewee questions –
- Please tell me what you know about advance directives and planning for death Advance Directives Video Presentation Paper
MT – I know a little about it from nursing school, we have a couple of classes that the Living Will and MPOA were covered. Also I know there’s an out of hospital DNR and an inpatient DNR.
KG – In my culture we don’t really talk about plans for dying, which isn’t good in my opinion, especially since I’ve learned about these topics in nursing school. I’ve also had the opportunity to add to my learning through my work at the hospital.
- Have you had to witness a MPOA or Living Will during the course of your job.
MT – No i haven’t
KG – Yes I had to witness more than once during a shift at the hospital
- Do you believe advance directives are necessary?
MT – Yes I think they are necessary and would like to learn more about them but I’m not sure they’re necessary for someone of my age. I feel like I’m young to think about those types of things.
KG – Yes I feel they’re necessary, especially after watching patients in ICU who didn’t have these documents. Their families agonized over whether they were making the right decisions or not.
- Have you had any experience with an inpatient DNR and/or a out of hospital DNR?
MT – I haven’t at my current job but I work in a clinic setting. The social worker usually talks about that stuff with the patients. Advance Directives Video Presentation Paper
KG – Yes I’ve seen patients have to complete the inpatient DNR and ask why they have to have 2 DNRs. I like to know as much as possible about this type of stuff because a lot of the patients I take care of are in a position that they might not leave the hospital. I would hate for them not to have the chance to be prepared for this.
- Now you’ve had a chance to review the Directive to Physicians and Family, and the Medical Power of Attorney. Do you feel like you understand these documents well enough to speak to patients about them should the need arise?
MT – I feel more confident than I did initially but would like to learn more. Honestly I hadn’t paid too much attention to this part of healthcare until you and I spoke and I had a chance to review the documents.
KG – It’s always good to review your learning. I would like to talk to my family about the need for this but I’m unsure how to approach them since it’s such a sticky subject. Advance Directives Video Presentation Paper
Hello everyone, and welcome to this video presentation. In this video, I will explore one of the vital topics, advance directives, which is not given the attention it requires. The video will also explore the available literature on advance directives and summarize interview results from the two interviews I conducted with registered nurses on this topic. Advance directives, also commonly known as a living will, is a document that patients fill out indicating how they want to be taken care of in case they are incapacitated and unable to make healthcare decisions for themselves. The common advance directive types include the living will, physician’s order of life-sustaining treatment, do not resuscitate orders, organ and tissue donation, and the durable power of attorney for healthcare (NIA, n.d.). Getting people to complete advanced directives is a difficult issue. However, it is advance care planning and completing advance directives is not only for the terminally ill or old patients; it is worth considering that anyone may face a medical crisis that limits them from making healthcare decisions.
Literature on Advance Care Planning and Advance Directives
Research shows that the number of people who have completed advance directives remains relatively low. According to McMahan, Tellez & Sudore (2021), only about 36.7% of adults in the US have completed advanced directives, meaning that only 1 in 3 people have engaged in advance care planning. The proportion is still relatively small, despite the efforts to promote the quality of end-of-life care by encouraging people to complete advance directives. According to the national institute of aging (NIA, n.d.), most geriatric and terminally ill patients, who are more likely to have advanced care planning, are still reluctant to complete advance directives. Advance Directives Video Presentation Paper
There are various barriers to completing advance directives. Morrison, Meier & Arnold (2021) note that despite the projections that efforts to advance care planning promote the use of advance care directives, improve end-of-life care, and act as a quality measure of end-of-life care, evidence and available scientific data do not support these projections. Therefore, it is essential to identify and understand some of the barriers to advance care planning. Blackwood et al. (2019) state that the primary barriers to advance care planning and completing advance directives are a lack of education and insufficient time. Inadequate education and training for care professionals regarding advance care planning and their role and responsibility of initiating the conversation with patients significantly affect advance care planning. Additionally, the conversation requires time, whereas there is insufficient time for nurses and other care providers to allow these conversations in often busy settings.
Furthermore, the barriers to advance care planning as perceived by patients and their families/caregivers include emotional barriers to engaging in the conversation, inadequate awareness and readiness to engage in the discussion, inadequate preparation from the healthcare systems and care providers, and limited patient engagement in autonomous decision-making (Chueng et al., 2020). Some severely/terminally ill patients have been emotionally affected by their illness to the extent that they cannot engage in the advance directives conversation. Additionally, most patients are not aware of advance care planning, and those who are aware are mostly not prepared to complete the directives. Some healthcare systems and providers have also not prepared adequately to engage patients in completing advance directives, and engage them in autonomous and shared decision-making concerning their end-of-life care, thus a significant barrier.
Mar (2017) notes that there are several limits to advance care planning and completing advance directives, which discourage patients who may want to complete advance directives. one of the limits is that even if an advance directive may be completed, the patient’s wishes may not always be granted. Some healthcare systems and care providers are reluctant to follow patients’ advance directives and may sometimes mistake them for being unethical, especially when the patient declines treatment. The care providers sometimes fear that following such advance directives, especially if they feel they may not lead to better care outcomes even in end-of-life care, might be morally wrong for them and unfair to the patient. Additionally, advance directives may be overlooked as mere documents, ignored, or misplaced, thus limiting the use of advance care planning. However, the National Council of State Boards of Nursing (2018) encourages healthcare systems and care providers to cultivate a culture whereby the patients’ wishes are fulfilled and advance directives are respected. The healthcare systems are also encouraged to store advance care directives in electronic medical records (EMR) to prevent misplacing the advance directive documents, thus getting more patients to trust the system when it comes to advance care planning and its effectiveness in improving the experience of end-of-life care. Advance Directives Video Presentation Paper
Interviews Summary
I conducted interviews with two registered nurses (MT and KG) on the issue of advance directives. The interviews aimed at assessing the registered nurses’ education, training, knowledge, and experience in advance care planning and advance directives. I developed five interview questions, which are what the nurses know about advance care planning and advance directives, whether the nurses have witnessed any advance directives such as MPOA or living will in the course of their job, whether they believe advance directives are necessary, any experience with do not resuscitate order, and whether they understand the documents well enough to lead the conversation with patients.
Generally, the interview responses showed that the nurses had learned about advance care planning and advance directives in school. However, they seem to have inadequate knowledge of the same since it has not been backed up by experience. The nurses believe completing health directives is essential, especially for terminally ill patients. “I believe advance directives are necessary, especially after witnessing family members agonizing over wondering whether they made the right decision for their patient” (KG, Personal Communication, February 15, 2023). From the responses, MT and KG indicated that they had not helped patients complete advance directives, despite having worked in ICU settings and witnessing family members stranded on the best choice for their ailing loved ones.
After reviewing the directive to physicians, family, and the Medical Power of Attorney, the nurses admitted that they had not paid adequate attention to these documents. However, both interviewees showed interest in learning more about the issue and interacting with these and more advance directive documents. “I feel more confident after reviewing these documents; honestly, I would like to learn more about this part of healthcare now that I have realized I gave it minimal attention” (MT, Personal communication, February 15, 2023). Advance Directives Video Presentation Paper
Conclusion
As I come to the end of this video presentation, I would like to point out some essential points learned from the literature and interview summary. Advance care planning and completing advance directives are imperative. However, research shows that the proportion of people who have completed the directives is still low despite the efforts to promote the issue. Healthcare systems should strategize on overcoming the barriers to advance care planning. Nurses have inadequate knowledge and experience to facilitate the conversation on advance care planning, despite acknowledging that it is necessary. Training and education to emphasize advance care planning is therefore needed. Advance Directives Video Presentation Paper
References
Blackwood, D. H., Walker, D., Mythen, M. G., Taylor, R. M., & Vindrola‐Padros, C. (2019). Barriers to advance care planning with patients as perceived by nurses and other healthcare professionals: a systematic review. Journal of Clinical Nursing, 28(23-24), 4276-4297. https://doi.org/10.1111/jocn.15049
Cheung, J. T., Au, D., Ip, A. H., Chan, J., Ng, K., Cheung, L., Yuen, J., Hui, E., Lee, J., Lo, L. & Woo, J. (2020). Barriers to advance care planning: a qualitative study of seriously ill Chinese patients and their families. BMC Palliative Care, 19(1), 1-9. https://doi.org/10.1186/s12904-020-00587-0#Abs1
Mar, J. (2017). How do you want to die? Write it down. https://www.kalw.org/show/crosscurrents/2017-01-24/how-do-you-want-to-die-write-it-down
McMahan, R. D., Tellez, I., & Sudore, R. L. (2021). Deconstructing the complexities of advance care planning outcomes: what do we know and where do we go? A scoping review. Journal of the American Geriatrics Society, 69(1), 234-244. https://doi.org/10.1111/jgs.16801
Morrison, R. S., Meier, D. E., & Arnold, R. M. (2021). What’s wrong with advance care planning? Jama, 326(16), 1575-1576. https://doi.org/:10.1001/jama.2021.16430
National Council of State Boards of Nursing. (2018). A nurse’s guide to professional boundaries. https://www.ncsbn.org/public-files/ProfessionalBoundaries_Complete.pdf
National Institute of Aging (n.d.). Advance Care Planning: Advance Directives for Healthcare. Retrieved from https://www.nia.nih.gov/health/advance-care-planning-advance-directives-health-care Advance Directives Video Presentation Paper
