Disclaimer. Ever believe in signs 09/24/2012. Objectives

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Disclaimer Susan Conley, MSN, RN-BC, ACNS-BC Bayhealth Medical Center I do not have any affiliation and have not received any financial support from any organization that could potentially bias this

1 Disclaimer Susan Conley, MSN, RN-BC, ACNS-BC Bayhealth Medical Center I do not have any affiliation and have not received any financial support from any organization that could potentially bias this program. Objectives Describe advance directive planning regarding end of life decisions Ever believe in signs For the conference MOLST Delaware presentation Verbalize methods to establish an advance directive(s) Medscape articles Death Is Not an Option, How You Die Is End of Life Care in the United States DONE presentation by Donna Casey 1

Patient Centered Care Has been defined as. Patients and families actively involved in the design of new care models and in decision-making about individual options for treatment.

2 Patient Centered Care Has been defined as. Patients and families actively involved in the design of new care models and in decision-making about individual options for treatment. The IOM defines patient-centered care as: Health care that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care. Retrieved on August 23, 2012, Patient Centered Care Patient-centered means bearing in mind patients cultural traditions, preferences and values, family situations, social circumstances and lifestyles. Formerly of IHI, Don Berwick, states, it is the experience (to the extent the informed, individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to one s person, circumstances, and relationships in health care. Joint Commission says Support the rights for a patient to make decisions regarding their care. So.. The hospital coordinates the patient s care, treatment and services based on the patient s needs Retrieved on August 23, 2012, Meehan, K.A

1963-1990-2005 Nevidjon, B.M. & Mayer, D.K.

regarding decisions toward their own medical care, that future care be dictated

3 History What were you doing in 1991? Karen Quinlan Nancy Cruzan Terri Schiavo Nevidjon, B.M. & Mayer, D.K. (2012) Patient Self Determination Act Purpose to inform patients of their rights regarding decisions toward their own medical care, that future care be dictated (via a living will or power of attorney) and communicated to the health care provider. Patient Self Determination Act Health care facilities and others Are required to provide information about advance health care directives to adult patients upon their admission to the healthcare facility. Required by Joint Commission and CMS 3

The What Advance Directives (AD) Document of a patients

Will Pt decides what to allow or decline as well and who can

Vent Relief from pain Other instructions Kelly, C.G.

What, MOLST The What, 5 Wishes Recognized in most states as

4 The What Advance Directives (AD) Document of a patients preferences for healthcare decisions should they lose the ability to communicate those wishes. Most common Living Will Power of Attorney The What, Living Will Pt decides what to allow or decline as well and who can make decisions Artificial nutrition Hydration CPR Mechanical Vent Relief from pain Other instructions Kelly, C.G., Lipson, A.R., Daly, B.J. and Douglas, S.L. (2006) The What, MOLST The What, 5 Wishes Recognized in most states as it is written Others (AL,NH, OH, IN, TX, KS,UT, OR) require it parallel that particular states statues. 4

5 The What The Who Health Care Power of Attorney- is the person or agent to make medical decisions for a patient should they not be able to do so for themselves. The Who Delaware Surrogate list Spouse (unless in the process of divorce) Adult Child Parent Adult brother or sister Adult grandchild If none of the above exist or are able. Someone who has exhibited special care/concern for the patient, who is familiar to the patient s values and is available to make decisions, is available and appointed as guardian by the Court of Chancery. Legal Handbook for Older Delawareans 2010 pg. 27 5

6 Literature Says 61% of Americans fear outliving their savings than the fear of dying 20-30% of America Adults report having an advance directive Affordable Care Act death panels dominated news, however did not increase conversations regarding end of life care Literature says Prevalence of advance directives is higher Females Caucasians Older individuals Insured privately Those with higher education Meehan, K. A Barriers Lack of communication (Dr, family), knowledge and time Want the family to do it. Afraid it wouldn t be followed Avoiding (Denial) Fear of discussing death Difficulty determining their POA Literacy level Difficulty with the forms More barriers Healthcare providers Lack of knowledge Discomfort personally with death Difficult communication with the patient and family Lack of time Meehan, K.A Walerius, T., Hill, P.D.,& Anderson, M.A

7 Who should initiate the Talk When Physicians Nurses Family Why Do not assume your SO/Family knows what to do! Why Discrepancy within family Over use of resources Decrease family burden Allows dying with dignity 7

National Healthcare Decisions Day, April 16th Mission National Healthcare Decisions Day exists

wishes regarding healthcare and for providers and facilities to respect those wishes, whatever

8 National Healthcare Decisions Day, April 16th Mission National Healthcare Decisions Day exists to inspire, educate & empower the public & providers about the importance of advance care planning. National Healthcare Decisions Day is an initiative to encourage patients to express their wishes regarding healthcare and for providers and facilities to respect those wishes, whatever they may be. How How dhss.delaware.gov/dhss/dsaapd/advance.html How Price: $5.00 (individual copies) or $1.00 (orders of 25 or more copies) 8

9 21 Century of Nursing Patient Centered Care Nurses are held to the highest level of trust We must be the change we wish to see in our health care world Educate ourselves Nevidjon, B. M. & Mayer, D.K. (2012) In the end 9

10 References State of Delaware website, dhss.delaware.gov/dhss Legal Handbook for Older Delawareans (2010)pg. 27 Kelly, C. G., Lipson, A. R., Daly, B.J. and Douglas, S. L. (2006). Use of Advance Directives in the Chronically Critically Ill. JONA s Healthcare Law, Ethics and Regulation (8),2, Meehan, K. A. (2009). Advance directives. The clinical nurse specialist as a change agent. Clinical Nurse Specialist 23 (5): National Healthcare Decision Day, References Nevidjon, B.M. & Mayer, D.K. (2012). Death is not an option, How you die is. Nurse Econ. 30 (3): Walerius, T., Hill, P.A. & Anderson, M.A. (2009). Nurses knowledge of advance directives, patient self determination act and Illinois advance directive law. Clinical Nurse Specialist, 23 (6): Patient centered care. Retrieved on August 23, 2012, 10

Cynthia Ann LaSala, MS, RN Nursing Practice Specialist Phillips 20 Medicine Advisor, Patient Care Services Ethics in Clinical Practice Committee

Cynthia Ann LaSala, MS, RN Nursing Practice Specialist Phillips 20 Medicine Advisor, Patient Care Services Ethics in Clinical Practice Committee What is Advance Care Planning (ACP)? Understanding/clarifying