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Advanced Directive


However, few patients are aware of how to go about constructing such directives even though the evidence indicates that most have clear preferences about how their end-of-life care should be managed. "A recent study in Maryland found that although 'only 34% of respondents had an AD, 61% indicated that they have preferences about medical care in the event they are unable to make such decisions', and of these '83% said it was very important that their preferences be carried out'" (Brown 2012)

Advanced Directive


Advanced Directive The 1991 the Patient Self-Determination Act (PSDA) was designed to give patients and their families greater autonomy over making decisions in regards to end-of-life care and minimizing the extension life beyond what would be considered a 'quality' level. It has been said that "advanced care planning increases the quality of life of dying patients, improves the experience of family members and decreases health care costs" for patients of a variety of backgrounds (Eggertson 2013)

Advanced Directive


Cultures may have various rituals and traditions regarding how illnesses is viewed and treated that the nurse should be aware of, even if she is offering a Westernized, medical perspective of how to proceed. When discussing end-of-life care, nurses should also be cognizant of the fact that loved ones may need counseling to deal with feelings of guilt or conflicts they might be experiencing about the choices of their relations (Kwon et al

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However, a recent case demonstrates how even loving family members who are in agreement can work to prevent a patient's wishes. Cancer patient SungEun Grace Lee had repeatedly expressed her desire to be removed from life support to her doctors at North Shore University Hospital in Manhasset, New York (Hartocollis, 2012)

Advanced Directive May Be One of the


As in other areas of healthcare, culture can have a significant impact on whether a patient is likely to seek an advanced directive, and, if not, if the family will be likely to carry out the patient's wishes. For example, Hispanics do not think that seriously ill patients should be fully informed about their illness, but, instead, that the family is obligated to take over in those scenarios (Lobar et al

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Nurses, doctors or other health care providers can not be a witness to the informed consent for DNR given by a patient. (Billings, 2008) Most states have specific laws regarding advance directives in a written format which permit any competent adult to prepare a legal document which expresses their wishes about their treatment during future medical conditions

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According to the PSDA or Patient Self-Determination Act of 1990, the control, language and format of any kind of advance directive must be in accordance to an individual state's law. (Sharpe, 1999); (Johnson, 2001) As per the PSDA, health care institutions must develop procedures and policies that recognize as well as honor the rights of a patient under the purview of state statutes to refuse or accept a particular kind of medical treatment

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It also helps to strengthen relationships by increasing communication between near and dear ones and settles the issue of "unfinished business." (Johnstone, 2004); ("Advance Directives

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However, the written format's language must stick to the specific laws of the state in which the patient resides. (Sharpe, 1999) Some states permit specific pre-hospital DNR only which can be followed by emergency response personnel

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Full acceptance and cooperation of patients, their families and care providers is essential for the full scale implementation of this very sensitive process. (Shewchuk, 1998) References American Academy of Orthopaedic Surgeons