Abstract

Background: Despite cardiovascular disease being the number one cause of death, advance directives are infrequently used in this population. The Patient Self- Determination Act (PSDA) took effect in 1991 to protect patients' autonomy and limit unnecessary suffering. Although hospitals fulfill the required PSDA documentation, patients lack understanding of advance directives, and physicians infrequently use Advance Care Planning (ACP). Health Care Proxy (HCP) is the essential first step in ACP.

Purpose: The purpose of this study is to examine the effect of a nurse practitioner-led promotion of ACP for hospitalized adult patients.

Theoretical Framework: The Shuler Nurse Practitioner Model and the Self- Determination Theory informed this study. The nurse practitioner is uniquely positioned to facilitate the patient's autonomy through Shuler's approach.

Method: A longitudinal case-control design was used to study the effect of nurse practitioner-led promotion of ACP in a convenience sample (n=120) of hospitalized patients with cardiovascular disease. In addition to the current practice, a nurse practitioner educated and encouraged patients to identify and document a HCP. Medical records of patients admitted prior to initiating the intervention (n=60) was compared to those receiving the intervention (n=60). HCP completion rate was the outcome of interest. A chi-square analysis was used to examine the effectiveness of the intervention.

Results: There is significant relationship between NP intervention and new HCP completion (Chi-square = 86.769, df = 1, p < 0.05). Patients were more likely to complete HCP when there is an NP-led ACP intervention. Prevalence of HCP improved from 35% in controls to 90% in cases.

Implications: Findings suggest nurse practitioners are effective in identifying and leveraging opportunities to facilitate ACP communication. Health care professionals are urged to empower patients to take full advantage of their self-determination.

Description

Proposing a Practice of Advance Care Planning by Nurse Practitioners to Prevent Futility and Alleviate Unnecessary Human Suffering at End of Life.

Author Details

Jaiby Joseph Augustine, DNP, RN, ANP-C

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Pilot/Exploratory Study

Keywords:

Health Care Proxy, Heart Disease, Ethical Challenges, Ethical Decision Making, End of Life, Resuscitation

Advisor

Shurpin, Kathleen M.

Degree

DNP

Degree Grantor

The State University of New York at Stony Brook

Degree Year

2015

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

Faculty Approved: Degree-based Submission

Acquisition

Self-submission

Date of Issue

2015-07-24

Full Text of Presentation

wf_yes

Download

Share

COinS