Health Care Decisions
This paper will have three parts addressing two important pieces of legislation related to the right of individuals to make health care decisions for themselves.
Part I
The Advance Health Care Directive
Locate a copy of an advanced directive (AD) that complies with the laws of the state in which you work. Download your state’s Advance Directives ( California) here http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3289. (Links to an external site.)
Complete the advance directive for yourself. Do not turn in your AD with your paper. The AD is for your personal use.
In your paper, Part I:
Identify where you obtained the AD and explain its compliance with state law.
Conduct research (1-2 sources) to learn more about the AD in your state and explain how it works.
Discuss how easy or difficult it was to complete the AD. Your comments should be specific and both objective and subjective. For example, when you state your personal feelings, you must relate them to the literature (textbook and research) that discusses this process and the difficulties that many people face when completing an advance directive.
(Cite/ reference any sources you use to explore these questions, including your texts.)
Part II
Physician Orders for Life-Sustaining Treatment (POLST) Form
What is a Physician Orders for Life-Sustaining Treatment (POLST) form (Links to an external site.)?
When should this form be completed?
Who can complete the form?
Who needs to sign the form to make it a legal document?
(Cite/reference any sources you use to explore these questions, including your texts.)
Part III
Tie the two first sections together by writing a summary and conclusion.
This section should address:
1. the differences between an Advance Health Care Directive and the POLST,
2. the RN’s important role in assuring the patient’s right to autonomy in choosing the healthcare interventions the patient does or does not want.
____________________________________________
Use current APA Style.
The paper should be between 3-5 pages in length excluding the title and reference page(s).
Cite and reference the course text and at least two (2) additional appropriate professional sources.
Review the rubric for further information on how your assignment will be graded.
Rubric
NURS_521_DE – Feild Activity Paper
NURS_521_DE – Feild Activity Paper
Criteria Ratings Pts
This criterion is linked to a Learning Outcome Content
50 to >43.5 pts
Meets Expectations
Content is clear, thorough, and organized effectively. Main points are well supported. Meets all of the criteria of the written assignment.
43.5 to >37.5 pts
Approaches Expectations
Content is somewhat clear, thorough, and organized effectively. Some points are well supported. Meets most of the criteria of the written assignment.
37.5 to >29.5 pts
Below Expectations
Content is generally unclear, not thorough, and organized ineffectively. Main points are not well supported. Meets only a few of the criteria of the written assignment.
29.5 to >0 pts
Does Not Meet Expectations
Content is disconnected, unorganized, and does not meet the criteria of the written assignment.
50 pts
This criterion is linked to a Learning Outcome Clarity and Coherence
50 to >43.5 pts
Meets Expectations
Writing flows smoothly from one idea to another. Writer has taken pains to assist the reader in following the logic of the ideas expressed.
43.5 to >37.5 pts
Approaches Expectations
Sentences are mostly structured to communicate ideas clearly. Transitions between paragraphs make the writer’s points easy to follow.
37.5 to >29.5 pts
Below Expectations
Sentence structure and word choice sometimes interfere with clarity of content and distract the reader.
29.5 to >0 pts
Does Not Meet Expectations
Poor sentence structure, sentences do not make sense; no clarity evident in the paper.
50 pts
This criterion is linked to a Learning Outcome References and Citations Within the Body of the Paper
12.5 to >10.88 pts
Meets Expectations
The required number of scholarly references is used and cited skillfully throughout the paper.
10.88 to >9.38 pts
Approaches Expectations
The required number of scholarly references is used but some may not be cited accurately or skillfully throughout the paper.
9.38 to >7.38 pts
Below Expectations
The required number of scholarly references is not used and most are not cited accurately or skillfully throughout the paper.
7.38 to >0 pts
Does Not Meet Expectations
References or citations are not included in the body of the paper and writing indicates none were used.
12.5 pts
This criterion is linked to a Learning Outcome Mechanics and APA
12.5 to >10.88 pts
Meets Expectations
The assignment consistently follows current APA format and is free from errors in formatting, citation, and references. No grammatical, spelling, or punctuation errors. All sources are cited and referenced correctly.
10.88 to >9.38 pts
Approaches Expectations
The assignment consistently follows current APA format with only isolated and inconsistent mistakes and/or has a few grammatical, spelling, or punctuation errors. Most sources are cited and referenced correctly.
9.38 to >7.38 pts
Below Expectations
The assignment generally follows current APA format with several mistakes and grammatical, spelling, or punctuation errors. Most sources are cited and referenced incorrectly.
7.38 to >0 pts
Does Not Meet Expectations
The assignment does not follow current APA format and/or has many grammatical, spelling, or punctuation errors. Sources are missing.
12.5 pts
Total Points: 125
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Solution
Part I
Identify where you obtained the AD and explain its compliance with state law.
I obtained the advance directive form from the state of California Department of Justice website. The advance directive form obtained from the Department of Justice website complied with the California State law in that it was readily available and also provided the option for patients to utilize different forms where necessary. By virtue of being readily available, the form was therefore easy for any member of the public to access and fill while also providing clear instructions on how the form should be filled (State of California Department of Justice, 2020).
Conduct research (1-2 sources) to learn more about the AD in your state and explain how it works.
In California, the advance healthcare directive provides instructions related to an individual’s health care. An individual can directly provide distractions related to their health care or appoint someone else to make healthcare decisions for them. Through the advanced directive, an individual can also express their wishes related to organ donation and the role that the primary care physician can play in their health. In California, individuals are also allowed to either modify a part of the whole of the advance directive form (Carr & Luth, 2017).
The first part of the advance healthcare directive form in California allows an individual to name another person as the main agent of their healthcare decisions in the instance that such individuals become incapable of making such decisions or if the given individual is capable of making their healthcare decisions but want someone else to make the decisions for them (Peicius et al., 2017). The California advance directive form also allows individuals to name an alternate agent that helps them in making their healthcare decisions if their first choice is not available or not willing to make healthcare decisions. In California, individuals are prohibited from appointing employees of community care facilities, healthcare operators, and health care providers in residential care facilities where they are receiving care or employees of any healthcare institutions as their agents unless such individuals are relatives or coworkers (Peicius et al., 2017).
In California, the agent nominated in the advance directive form possesses all the authority to make all healthcare decisions for a specific individual. However, the individual nominating an agent to make healthcare decisions for them can limit the authority of the nominated agents. Generally, individuals who nominate agents to make healthcare decisions for them are advised not to limit their authority if they wish to rely on such agents to make healthcare decisions for them in the future (Peicius et al., 2017). In California, agents that exercise full authority to make health care decisions for an individual normally have the right to select or discharge institutions or health care providers of a concerned individual, refuse to consent or consent to a given treatment, care procedure, or service that can affect the physical or mental health condition of the concerned individual. In California, a nominated agent also has the authority to disapprove or approve surgical procedures, diagnostic tests, and programs of medication for the concerned patient who nominated them. A nominated agent in California can also direct various proceedings related to the withdrawal or withholding of artificial nutrition, hydration, and cardiopulmonary resuscitation. Finally, a nominated agent in California can make decisions related to the donation of tissues, parts, and organs, authorize an autopsy, and be involved in directing how the remains of an individual will be disposed of (Carr & Luth, 2017).
The advanced directive form in California also provides an individual with an opportunity to provide specific instructions on various aspects of their healthcare, such as whether to appoint an agent or not. An individual is also provided with an opportunity to express their wishes related to withdrawal withholding or provision of treatments that can extend their life or relieve pain. Individuals are also provided with space to provide additional wishes related to their care in the instance that they would not be in a condition to make their own decision (Carr & Luth, 2017). Individuals who are satisfied with the ability of the agents to make healthcare decisions for them, including end-of-life decisions, are not required to fill the second part of the advance directive formed in California.
The third part of the advance directive form in California allows an individual to express their intention of whether to donate any organs, tissues, or other body parts following their death. The fourth part of the California advance directive form allows an individual to designate physicians as the ones with the primary responsibility of one’s health. In California, individuals are allowed to revoke their advance healthcare directive or replace it at any time they may wish to do so (Peicius et al., 2017).
Discuss how easy or difficult it was to complete the AD.
Completing the California advance health care directive form was quite challenging for me because of several issues, including a general discomfort towards the end of life discussions, cultural issues, and a lack of adequate knowledge on the importance of the advance directive form and time constraints. When filling out the advance directive form, I found the process of advance care planning to be quite uncomfortable, especially because it is related to end-of-life decisions and discussions. Generally, the end-of-life discussions in the advance directive form pushed me out of my comfort zone. According to Carr & Luth (2017), many individuals don’t think about advance directives or end-of-life planning, while nurse practitioners, physician assistants, and physicians do not receive adequate training on how to initiate end-of-life discussions with their patients and introduce the idea of completing an advance directive. The American culture, which includes a never-say-die attitude and never quitting or losing, also had a significant impact on me during the feeling of the advance directive. End-of-life discussions are therefore difficult in a culture where people do not like to speak about dying, death or disability because it represents a kind of loss, including loss of ability to be independent or loss of life. According to Peicius et al. (2017), it’s difficult for Americans to be involved in discussions related to the end of life because it represents a loss which is something that the culture significantly discourages. The third challenge that I faced related to the filling of the advance directive form was related to the lack of adequate knowledge on the importance of the advance directive form. I did not understand several sections of the advance directive form. According to Carr & Luth (2017), a lot of education is needed both among healthcare providers and the general public to improve the understanding of the advance directive form and its importance. In addition to patient health care, practitioners need more education on areas related to advance directives and end-of-life planning and how they can approach conversations related to advance directives and end-of-life planning with patients and their families. Finally, I faced challenges related to time constraints when filling out the advance directive form. Filling the AD form requires a lot of time to have proper discussions and to make informed decisions related to end-of-life planning. According to Carr & Luth (2017), most patients are not concerned with filling the advance directive forms but want to discuss how their ailment or current discomfort can be addressed immediately to improve their quality of life. The significant amount of time required to make informed decisions when filling the advance directive form acts as a significant barrier that deters numerous individuals from filling such a form.
Part II
What is a Physician Orders for Life-Sustaining Treatment (POLST) form (Links to an external site.)?
Physician orders for life-sustaining treatment (POLST) is a physician order that provides a specific plan for end-of-life care that considers both patients’ preferences and physician’s judgment that is based on medical evaluation of the patient (Mack & Dosa, 2019). The POLST allows patients and physicians to come up with default orders related to end-of-life care that can be clearly and succinctly conveyed to different healthcare practitioners and healthcare facilities when the patient is at home, in transit between locations, in the emergency department, or long-term care facility (Mack & Dosa, 2019).
When should this form be completed?
A POLST should be completed for patients who have less than one year to live, which includes patients in end-stage organ diseases, patients in metastatic stages, patients receiving palliative and hospice care, and patients with terminal diagnoses. A POLST should also be considered for patients who reside permanently in long-term care facilities (Mack & Dosa, 2019).
Who can complete the form?
A POLST form should be completed by professionals who have undergone special training related to the form and who work with the patient’s physician or the physician himself in collaboration with the patient. A POLST should therefore consider the patient’s current health situation, their treatment preferences, and future health conditions (Mack & Dosa, 2019).
Who needs to sign the form to make it a legal document?
Both the patient and the physician must sign a POLST to make it a legal document. Among patients who do not have the capacity to make medical decisions, the legally recognized decision-maker for the patient can be involved in completing and signing the POLST in collaboration with a physician (Mack & Dosa, 2019).
Part III
The differences between an Advance Health Care Directive and the POLST
There are several differences between an Advance Health Care Directive and the POLST. One of the main differences between the AD and the POLST is that the advance directive is a direction from a patient, and it’s not a medical order. In contrast, a POLST form is made up of specific medical orders that are specific to limited patient populations and which address a specific critical medical decision (Carr & Luth, 2017). The advance directive and therefore be filled by any competent adult across the population while a POLST form only targets individuals whose death is imminent such as those having a terminal diagnosis does permanently residing in long-term care facilities, individuals with end-stage organ diseases, or final stages of cancer and those receiving palliative or hospice care. The ad is a legal document, while a POLST is a medical order. The AD is completed by an individual, while the POLST is completed by healthcare professionals in collaboration with a patient (Mack & Dosa, 2019).
The RN’s important role in assuring the patient’s right to autonomy in choosing the healthcare interventions the patient does or does not want.
Registered nurses have an important role to play in ensuring that the right to autonomy of the patient is conserved when choosing health care interventions. To promote patient autonomy and to help in the preservation of the rights to autonomy among patients, nurses have to be actively involved in educating patients on various treatment interventions and their benefits and shortcomings. Registered nurses need to realize that patients can only effectively exercise their autonomy from the point of information and not from the point of ignorance (Peicius et al., 2017).
References
Carr, D., & Luth, E. A. (2017). Advance Care Planning: Contemporary Issues and Future Directions. Innovation in Aging, 1(1). https://doi.org/10.1093/geroni/igx012
Mack, D. S., & Dosa, D. (2019). Improving Advance Care Planning through Physician Orders for Life-Sustaining Treatment (POLST) Expansion across the United States: Lessons Learned from State-Based Developments. American Journal of Hospice and Palliative Medicine®, 37(1), 19–26. https://doi.org/10.1177/1049909119851511
Peicius, E., Blazeviciene, A., & Kaminskas, R. (2017). Are advance directives helpful for good end of life decision making: a cross-sectional survey of health professionals. BMC Medical Ethics, 18(1). https://doi.org/10.1186/s12910-017-0197-6
State of California Department of Justice. (2020). State of California – Department of Justice – Office of the Attorney. State of California – Department of Justice – Office of the Attorney General. Retrieved February 5, 2022, from https://oag.ca.gov/