Field Activity Paper
Part I: The Advance Healthcare Directive
An advance healthcare directive refers to a legally binding document highlighting instructions for an individual’s healthcare if they can no longer make or communicate their decisions by themselves (House et al., 2022). Advance directives recognize patients’ autonomy regarding their healthcare as well as the right to appoint other individuals to make their healthcare decisions. Advance directives protect patients’ right to refuse undesired treatments in the event of an inability to make such decisions (House et al., 2022). The California advance directive form consists of five parts, namely, power of attorney for healthcare, individual instructions, donations of organs at death, primary physician, and execution (California advance health care directive, 2020).
Power of attorney for healthcare allows an individual to designate an agent to make healthcare decisions. This provision also allows for the appointment of alternate agents. The authority of the attorney for healthcare is effectuated once an individual is in a medical situation considered by the state’s laws as permanent unconscious. An individual can choose to limit the authority of the agent related to healthcare decision-making. Meanwhile, the instructions for healthcare allow you to give specific instructions regarding the provision, withholding, or withdrawal of treatment to keep you alive, as well as the provision of pain relief, whether or not an agent has been selected. It is also applied at the end of life when an individual is permanently ill or unconscious (California advance health care directive, 2020). Donations of organs at death and primary physician sections allow individuals to express intentions regarding their organs following death and appoint and appoint primary physicians to be responsible for their healthcare, respectively. Finally, the signature section is crucial as it makes the document formal and binding.
In California, the healthcare decisions act is the law that forms the advance directives. The act is based on the Uniform Law Commission’s Uniform Health Care Decisions Act, which is in the California Probate Code at sections 3670 through 4808 (California advance health care directive, 2020). These directives grant patients the right to appoint an agent and give instructions for their healthcare. Additionally, the document facilitates discussion of wishes regarding Medicare in the event one is incapable of making decisions. Completing the advance directive forms can be quite difficult since it possesses thoughtful and composite decisions. It requires an individual to understand their healthcare needs comprehensively. Additionally, most of our decisions are based on former experience, which is not the case with end-of-life issues, as patients may not be in a position to choose between hostile and comfortable care when they are unconscious.
Part II: Physician Orders for Life-Sustaining Treatment (POLST) Form
The POLST form is structured to complement advance directives in seriously ill and frail patients. The form targets to align end-of-life care with patients’ preferences (Scotti & Brangoccio, 2019). POLST forms are filled by a physician following an elaborate and comprehensive conversation between the patient and the healthcare provider. The document consists of decisions made in the presence of a patient’s current illness. It allows an individual to make decisions regarding specific interventions such as mechanical ventilation, artificial feeding, and cardiopulmonary resuscitation. Completion of POLST forms and their importance is based on the individual’s religious and moral beliefs. However, completion is voluntary and helps patients receive desired treatment (Vranas et al., 2020). Additionally, POLST forms may contain treatment orders beyond comfort measures which principally keep a person comfortable rather than prolonging or sustaining life. POLST forms become legal documents once signed by a medical provider (Scotti & Brangoccio, 2019). However, in California, nurse practitioners and physician assistants may sign the forms under the supervision of a physician to make them legally binding. Once signed, these medical orders should be carried by patients across all healthcare settings and cannot be overruled.
Summary and Conclusion
The Advance healthcare directives and POLST forms both emphasize future healthcare plans. They aim at ensuring patients’ end-of-life care is by their preferences. Nonetheless, they differ significantly. For instance, the advance health care directive is completed by patients and enables them to give instructions for their healthcare and appoint proxies in the event of inability to make these decisions. In contrast, the POLST form is completed by a physician following an intensive discussion with the patient and is principally meant for frail and seriously ill patients. As opposed to advance healthcare directives, the POLST form is completed in the event of a known current illness. Additionally, the advance healthcare directive is signed by the patient to become legally binding, while the POLST form must be signed by the physician to become a medical order. Finally, the POLST form has to be carried by patients across all healthcare settings, unlike the advance healthcare directives form, which is stored in the registry.
End-of-life care is an essential role of a registered nurse. End of life presents an ethical dilemma for both patients and nurses. However, registered nurses have a critical role in ensuring patients’ autonomy during the end-of-life process by giving the necessary information and empowering patients to participate in healthcare decision-making. Additionally, nurses must respect patients’ autonomy regardless of the treatment choice made by the patient. Finally, nurses must advocate for patient autonomy which is usually breached by pressure from families and healthcare provider teams.
California Advance Health Care Directive. (2020). Stanford.edu. https://med.stanford.edu/content/dam/sm/bioethics/documents/AdvanceDirective_English-easy-read.pdf
House, S. A., Schoo, C., & Ogilvie, W. A. (2022). Advance Directives. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459133/
Scotti, S., & Brangoccio, K. (2019). Physician Orders for Life-Sustaining Treatment. Ncsl.org. https://www.ncsl.org/research/health/physician-orders-for-life-sustaining-treatment.aspx
Vranas, K. C., Lin, A. L., Zive, D., Tolle, S. W., Halpern, S. D., Slatore, C. G., Newgard, C., Lee, R. Y., Kross, E. K., & Sullivan, D. R. (2020). The association of physician orders for life-Sustaining Treatment with the intensity of treatment among patients presenting to the emergency department. Annals of Emergency Medicine, 75(2), 171–180. https://doi.org/10.1016/j.annemergmed.2019.05.008
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.
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. The organization in which you work should have a copy of an advance directive that is given to patients. If not, download your state\’s Advance Directives 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.)
Physician Orders for Life-Sustaining Treatment (POLST) Form
What is a Physician Orders for Life-Sustaining Treatment (POLST) formLinks 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.)
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.