Title: Analysis of Advance Directives and the Role of Registered Nurses in Ensuring Patient Autonomy in Healthcare Decision-Making
The right of individuals to make healthcare decisions for themselves is a fundamental aspect of patient autonomy. To uphold this right, various legal provisions and frameworks have been established, including advance directives and Physician Orders for Life-Sustaining Treatment (POLST). This paper aims to analyze the differences between advance health care directives and POLST, as well as highlight the critical role of registered nurses (RNs) in ensuring patient autonomy in choosing healthcare interventions.
Part I: Differences between Advance Health Care Directives and POLST
Advance Health Care Directive:
An Advance Health Care Directive (AD) is a legal document that allows individuals to express their preferences and wishes regarding medical treatment and end-of-life care. It is typically created when the person is competent and can make informed decisions about their healthcare. ADs provide instructions for healthcare professionals and family members regarding the types of treatment the individual wants or does not want in specific medical situations. They are often composed of two main components: the living will and the healthcare proxy.
The living will articulates the individual’s desires for medical interventions and treatments in situations where they are unable to communicate their preferences due to incapacitation. It may address issues such as resuscitation, administration of medication, use of artificial nutrition, and other life-sustaining interventions. The healthcare proxy designates a trusted person to make healthcare decisions on behalf of the individual if they become incapable of doing so themselves.
Physician Orders for Life-Sustaining Treatment (POLST) is another form of advance care planning, specifically designed for seriously ill or frail individuals who have limited life expectancy. POLST forms are generally completed by a healthcare professional in consultation with the patient or their surrogate decision-maker. Unlike ADs, POLST documents contain medical orders that guide emergency medical personnel about the types of treatments the patient wants or does not want to receive in pre-defined situations. These orders are printed on brightly colored paper and are instantly recognizable by healthcare providers.
The primary distinction between ADs and POLST lies in the level of specificity and legal enforceability. ADs are more general and allow individuals to outline their treatment preferences, but actual implementation of these preferences may require interpretation by healthcare providers. On the other hand, POLST provides explicit medical orders that guide healthcare professionals in situations where immediate decisions need to be made, carrying a higher degree of legal enforceability.
Part II: The RN’s Role in Assuring Patient Autonomy
Registered nurses play a pivotal role in promoting patient autonomy and ensuring that individuals’ rights to make healthcare decisions are respected. The RN’s role involves several key responsibilities:
1. Patient Education and Advocacy:
RNs are responsible for educating patients about advance care planning, including the importance of advance directives and POLST. They provide information to patients, their families, and surrogate decision-makers, enabling them to make informed decisions regarding healthcare interventions. By promoting patient understanding and involvement in decision-making processes, RNs enhance patient autonomy.
2. Documentation and Communication:
RNs are responsible for documenting patients’ advance care directives and POLST in their medical records accurately. They ensure that these documents are accessible to all healthcare providers involved in the patient’s care, enabling appropriate adherence to the patient’s preferences. Effective communication of these directives and orders among healthcare team members is crucial in maintaining continuity of care and respecting patient autonomy.
3. Decision-Making Support:
RNs play an active role in interdisciplinary care teams, which includes discussing advance care planning with patients, their families, and healthcare providers. They act as advocates for patients by facilitating communication and shared decision-making processes. RNs collaborate with other healthcare professionals to ensure that treatment decisions align with the patient’s expressed wishes as documented in their advance directives or POLST.
4. Ethical Considerations:
RNs must navigate complex ethical dilemmas related to patient autonomy. They ensure that patients’ choices and preferences regarding healthcare interventions are respected, while also balancing legal and ethical obligations. In situations where conflicts arise, RNs may consult with ethics committees or seek guidance from experienced professionals to ensure appropriate decision-making.
Advance directives and POLST are essential tools for individuals to exercise their right to make healthcare decisions for themselves. While ADs provide general guidelines, POLST offers explicit medical orders for immediate decision-making. Registered nurses play a critical role in promoting patient autonomy by educating and advocating for patients, facilitating communication, ensuring accurate documentation, and navigating ethical considerations. By upholding these responsibilities, RNs contribute to preserving patients’ rights and fostering a patient-centered approach to healthcare decision-making.