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When, how, and why of advance directives: tools for the cardiovascular nurse
1Surgical Heart Services, Columbus, OH 43214, USA.
Insights
The Patient Self Determination Act (PSDA) empowers patients with end-of-life decision rights. However, limited healthcare industry acceptance and public knowledge of advance directives persist nearly a decade after its implementation.
Area of Science:
- Cardiovascular Medicine
- Healthcare Policy
- Bioethics
Background:
- Cardiovascular disease remains the leading cause of death in the U.S., necessitating difficult end-of-life decisions for patients and families.
- The Patient Self Determination Act (PSDA), enacted in 1991, aimed to empower individuals in making these critical choices.
- Despite the PSDA's goals, literature suggests limited healthcare industry adoption and public awareness of advance directives.
Purpose of the Study:
- To examine the practical and clinical application of advance directives for cardiovascular patients.
- To highlight special considerations for end-of-life choices in cardiovascular care.
- To provide cardiovascular nurses with essential facts, resources, and information for discussing advance directives.
Main Methods:
- Review of existing literature on the Patient Self Determination Act and advance directives.
- Analysis of the implications of the PSDA within healthcare settings receiving federal reimbursement.
- Focus on practical applications and clinical considerations for cardiovascular nursing.
Main Results:
- Evidence indicates a lack of widespread acceptance of the PSDA within the healthcare industry.
- Public knowledge and utilization of advance directives remain notably limited.
- The PSDA mandates healthcare institutions to inform patients and designate staff for advance directive discussions.
Conclusions:
- The PSDA's intent to facilitate patient autonomy in end-of-life care is not fully realized.
- There is a critical need to enhance healthcare provider and public understanding and implementation of advance directives.
- Cardiovascular nurses play a vital role in educating patients and facilitating end-of-life discussions.
Abstract:
In the U.S., cardiovascular disease is the number one cause of death. The chronicity and unpredictable nature of cardiovascular disease will affect thousands of patients and families who are often called upon to make difficult end of life choices. The federal legislation of the Patient Self Determination Act (PSDA) was passed in 1990 and went into affect in December of 1991. The essence of this legislation was to empower the public with the right to make end of life decisions. However, after almost 10 years of implementation there is little evidence of national acceptance by the health care industry as evident in the literature. Likewise, the public demonstrates limited knowledge regarding advance directives. The law applies to all health care facilities that receive any federal reimbursement for services and includes hospitals, nursing homes, home health agencies, and clinics. The PSDA requires health care institutions to establish mechanisms for disseminating information about advance directive, to patients and to designate personnel responsible for discussing advance directives with patients. In this paper, practical and clinical application to the special considerations of the patient and end of life choices will be discussed. A focus on facts, resources, and other information will be presented for the cardiovascular nurse in a variety of health care settings.