2.50
Hdl Handle:
http://hdl.handle.net/10755/157075
Category:
Abstract
Type:
Presentation
Title:
Descriptive Evaluation of Patient Perception of Advance Directives
Author(s):
Johnson, Rebecca W.; Granger, Bradi
Author Details:
Rebecca W. Johnson, RN,BS, Duke Hospital, Duke University Health System, Durham, North Carolina, USA, email: johns151@mc.duke.edu; Bradi Granger
Abstract:
POSTER PURPOSE: In our ICU, the presence of an advance directive (AD) is assessed on admission; however, few patients have an AD and patientsÆ understanding of the issues is unclear. The purpose of this prospective, qualitative descriptive study was to evaluate current practice of informing patients about ADs. Our aims were to determine if patients understand ADs, have a health care power of attorney (HC POA), and have discussed their end-of-life wishes with that HC POA. BACKGROUND/SIGNIFICANCE:The Patient Self-Determination Act (PSDA) includes informing patients of the right to a natural death and the right to prepare an AD. Though ADs are offered to all adult patients, completion rates are <50%. At our hospital, the PSDA requirement is operationalized by nurses who ask patients on admission, "Do you have a North Carolina AD?" We recognized that poor patient understanding of ADs may contribute to poor completion rates and result in indeterminate choices for care at the end of life. METHOD: A prospective, descriptive qualitative study of adult patients (n = 626) admitted to our cardiac care unit in an 850-bed teaching hospital was conducted. Data were collected in compliance with the federal PSDA, HIPAA, and state regulations for HC-POA. Patients were asked a standard question regarding AD status and 3 additional clarifying statements to assess understanding of HC-POA. Descriptive statistics were reported for age, sex, and race. The relationship between understanding of ADs and satisfaction with designated HC-POA was analyzed using a 2 test for categorical differences and a t test for continuous variables. PatientsÆ responses were analyzed by using content analysis. RESULTS: Of 625 patients enrolled, 179 already had an AD and 116 were deferred due to inability to communicate. Of the remaining 330 patients, 72 (16%) were asked if they wanted to complete an AD, but answered no, yet when asked "Do you know what an AD is?" also answered no. Discordance between AD completion and understanding represents being uninformed, the sentinel theme of these findings. In addition, 248 (75%) were happy with their legal HC-POA, but when asked "Have you discussed your end-of-life wishes with your HC POA?" 157 (63%) stated no, further contributing to the theme uninformed. Quantitative analyses support findings of declining an AD and lack of understanding of an AD (2 = 31.5, P > .0001). CONCLUSIONS: Our findings show that many patients without an AD lack an understanding of the importance of the AD document for ensuring that their wishes are carried out. It is equally important that nurses go beyond just informing patients of their rights; in addition they must make certain that patients understand ADs and the need to communicate wishes to the HC-POA in order to meet the full intent of the PSDA. The simple question "Do you have an AD?" is not enough.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866
Conference Date:
2010
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
Washington, D.C., USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleDescriptive Evaluation of Patient Perception of Advance Directivesen_GB
dc.contributor.authorJohnson, Rebecca W.en_GB
dc.contributor.authorGranger, Bradien_GB
dc.author.detailsRebecca W. Johnson, RN,BS, Duke Hospital, Duke University Health System, Durham, North Carolina, USA, email: johns151@mc.duke.edu; Bradi Grangeren_GB
dc.identifier.urihttp://hdl.handle.net/10755/157075-
dc.description.abstractPOSTER PURPOSE: In our ICU, the presence of an advance directive (AD) is assessed on admission; however, few patients have an AD and patients&AElig; understanding of the issues is unclear. The purpose of this prospective, qualitative descriptive study was to evaluate current practice of informing patients about ADs. Our aims were to determine if patients understand ADs, have a health care power of attorney (HC POA), and have discussed their end-of-life wishes with that HC POA. BACKGROUND/SIGNIFICANCE:The Patient Self-Determination Act (PSDA) includes informing patients of the right to a natural death and the right to prepare an AD. Though ADs are offered to all adult patients, completion rates are <50%. At our hospital, the PSDA requirement is operationalized by nurses who ask patients on admission, "Do you have a North Carolina AD?" We recognized that poor patient understanding of ADs may contribute to poor completion rates and result in indeterminate choices for care at the end of life. METHOD: A prospective, descriptive qualitative study of adult patients (n = 626) admitted to our cardiac care unit in an 850-bed teaching hospital was conducted. Data were collected in compliance with the federal PSDA, HIPAA, and state regulations for HC-POA. Patients were asked a standard question regarding AD status and 3 additional clarifying statements to assess understanding of HC-POA. Descriptive statistics were reported for age, sex, and race. The relationship between understanding of ADs and satisfaction with designated HC-POA was analyzed using a 2 test for categorical differences and a t test for continuous variables. Patients&AElig; responses were analyzed by using content analysis. RESULTS: Of 625 patients enrolled, 179 already had an AD and 116 were deferred due to inability to communicate. Of the remaining 330 patients, 72 (16%) were asked if they wanted to complete an AD, but answered no, yet when asked "Do you know what an AD is?" also answered no. Discordance between AD completion and understanding represents being uninformed, the sentinel theme of these findings. In addition, 248 (75%) were happy with their legal HC-POA, but when asked "Have you discussed your end-of-life wishes with your HC POA?" 157 (63%) stated no, further contributing to the theme uninformed. Quantitative analyses support findings of declining an AD and lack of understanding of an AD (2 = 31.5, P > .0001). CONCLUSIONS: Our findings show that many patients without an AD lack an understanding of the importance of the AD document for ensuring that their wishes are carried out. It is equally important that nurses go beyond just informing patients of their rights; in addition they must make certain that patients understand ADs and the need to communicate wishes to the HC-POA in order to meet the full intent of the PSDA. The simple question "Do you have an AD?" is not enough.en_GB
dc.date.available2011-10-26T19:23:56Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:23:56Z-
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.conference.date2010en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationWashington, D.C., USAen_GB
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.