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Strategies for Nurse Advocacy
This table lists some potential problems associated
with advance directives and highlights possible advocacy
actions for the nurse.
Table 2:
Advance Directives
|
POTENTIAL PROBLEM
|
POSSIBLE NURSE
ACTION
|
| Patients can't necessarily predict
their future preferences and they know too little
about what "life support" means |
- Patient education
- Provide information that advance directives
can be changed at any time up to incapacity
|
| Patients may change their minds |
- Patient education
- Provide information that advance directives
can be changed at any time up to incapacity
|
| The health care proxy may turn out
to be a poor choice and make decisions that are
obviously not in line with patient's earlier stated
preferences |
Proactive discussion with patients
about who would make a good proxy - not necessarily
the person closest to the patient |
| Treatment directives are too vague
and open to divergent interpretation |
Inform patient that one can't plan
for every eventuality therefore assistance in choosing
an appropriate proxy is helpful |
| Even the most diligent proxy cannot
necessarily tell what the patient would have wanted
in certain circumstances especially in the absence
of a written directive |
Other standards such as that of the
"reasonable person" can be helpful |
| The proxy may make a treatment choice
contrary to the patient's written directive |
Ethics consult/committee involvement |
| The proxy may make a decision with
which the institution or physician disagrees |
Ethics consult/committee involvement |
| The proxy decision-maker may find
the burden of decision making too overwhelming |
Assistance from health care team/ethics
resource |
Resources:
Hiltunen, E. F., Medich, C.,
Chase, C., Peterson, L., & Forrow, L. (1999) Family
decision making for end-of life-treatment:The SUPPORT
nurse narratives. The Journal of Clinical Ethics,
10(2), 126-134.
Marshall, P. A. (1995). The SUPPORT study: Who's talking?
Hastings Center Report, 25(6), S9-S11.
Wolf, S. M. (2001/1991). Sources of concern about the
Patient Self-Determination Act. In W. Teays, & L.
Purdy (Eds.), Bioethics, justice and health care,
(pp.411-419). Belmont, CA: Wadsworth. Reprinted from
New England Journal of Medicine, 325(23),1991,
1666-1671.
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