Advance Care Planning in Patients with Heart Disease: A Practice Improvement Initiative

12.20
Hdl Handle:
http://hdl.handle.net/10755/560969
Category:
Full-text
Type:
DNP Capstone Project
Level of Evidence:
Case-Control Study
Research Approach:
Pilot/Exploratory Study
Title:
Advance Care Planning in Patients with Heart Disease: A Practice Improvement Initiative
Author(s):
Augustine, Jaiby Joseph
Advisors:
Shurpin, Kathleen M.
Degree:
DNP
Degree Year:
2015
Grantor:
Stony Brook University, The State University of New York
Abstract:

Advance Care Planning in Patients with Heart Disease: 

A Practice Improvement Initiative

Jaiby Joseph Augustine DNP RN ANP-C 


Abstract

Background: Despite cardiovascular disease being the number one cause of death, advance directives are infrequently used in this population. The Patient Self- Determination Act (PSDA) took effect in 1991 to protect patients’ autonomy and limit unnecessary suffering. Although hospitals fulfill the required PSDA documentation, patients lack understanding of advance directives, and physicians infrequently use Advance Care Planning (ACP). Health Care Proxy (HCP) is the essential first step in ACP.

Purpose: The purpose of this study is to examine the effect of a nurse practitioner-led promotion of ACP for hospitalized adult patients.

Theoretical Framework: The Shuler Nurse Practitioner Model and the Self- Determination Theory informed this study. The nurse practitioner is uniquely positioned to facilitate the patient’s autonomy through Shuler’s approach.

Method: A longitudinal case-control design was used to study the effect of nurse practitioner-led promotion of ACP in a convenience sample (n=120) of hospitalized patients with cardiovascular disease. In addition to the current practice, a nurse practitioner educated and encouraged patients to identify and document a HCP. Medical records of patients admitted prior to initiating the intervention (n=60) was compared to those receiving the intervention (n=60). HCP completion rate was the outcome of interest. A chi-square analysis was used to examine the effectiveness of the intervention.

Results: There is significant relationship between NP intervention and new HCP completion (Chi-square = 86.769, df = 1, p < 0.05). Patients were more likely to complete HCP when there is an NP-led ACP intervention. Prevalence of HCP improved from 35% in controls to 90% in cases.

Implications: Findings suggest nurse practitioners are effective in identifying and leveraging opportunities to facilitate ACP communication. Health care professionals are urged to empower patients to take full advantage of their self-determination. 

Citation:
Augustine, J.J. (2015, May). Advance care planning in patients with heart disease: A practice improvement initiative (Doctoral capstone project). Retrieved from http://www.nursinglibrary.org/vhl/handle/10755/560969
Keywords:
Health care proxy; Heart Disease; ethical challenges; Ethical decision making; End of Life; Resuscitation
MeSH:
Advance Care Planning; Advance Directives; Heart Diseases; Terminal Care; Resuscitation Orders
CINAHL Headings:
Decision Making, Ethical
Description:
Proposing a Practice of Advance Care Planning by Nurse Practitioners to Prevent Futility and Alleviate Unnecessary Human Suffering at End of Life.
Note:
This work has been approved through a faculty review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.
Repository Posting Date:
2015-07-24T19:42:45Z
Date of Publication:
2015-07-24

Full metadata record

DC FieldValue Language
dc.contributor.advisorShurpin, Kathleen M.en
dc.contributor.authorAugustine, Jaiby Josephen
dc.date.accessioned2015-07-24T19:42:45Zen
dc.date.available2015-07-24T19:42:45Zen
dc.date.issued2015-07-24en
dc.identifier.citationAugustine, J.J. (2015, May). Advance care planning in patients with heart disease: A practice improvement initiative (Doctoral capstone project). Retrieved from http://www.nursinglibrary.org/vhl/handle/10755/560969en
dc.identifier.urihttp://hdl.handle.net/10755/560969en
dc.descriptionProposing a Practice of Advance Care Planning by Nurse Practitioners to Prevent Futility and Alleviate Unnecessary Human Suffering at End of Life.en
dc.description.abstract<div class="page" title="Page 1"> <div class="layoutArea"> <h3 class="column" style="text-align: center;">Advance Care Planning in Patients with Heart Disease: </h3> <h3 class="column" style="text-align: center;"><span style="font-size: 10pt;">A Practice Improvement Initiative</span></h3> <div class="column" style="text-align: center;"> <p style="text-align: center;"><span>Jaiby Joseph Augustine DNP RN ANP-C </span></p> <h3 style="text-align: center;"><span style="font-size: 10pt;"><br /></span></h3> <h3 style="text-align: center;"><span style="font-size: 10pt;">Abstract</span></h3> <p style="text-align: left;"><span>Background: </span><span>Despite cardiovascular disease being the number one cause of death, advance directives are infrequently used in this population. The Patient Self- Determination Act (PSDA) took effect in 1991 to protect patients’ autonomy and limit unnecessary suffering. Although hospitals fulfill the required PSDA documentation, patients lack understanding of advance directives, and physicians infrequently use Advance Care Planning (ACP). Health Care Proxy (HCP) is the essential first step in ACP. </span></p> <p style="text-align: left;"><span>Purpose: </span><span>The purpose of this study is to examine the effect of a nurse practitioner-led promotion of ACP for hospitalized adult patients. </span></p> <p style="text-align: left;"><span>Theoretical Framework: </span><span>The Shuler Nurse Practitioner Model and the Self- Determination Theory informed this study. The nurse practitioner is uniquely positioned to facilitate the patient’s autonomy through Shuler’s approach. </span></p> <p style="text-align: left;"><span>Method: </span><span>A longitudinal case-control design was used to study the effect of nurse practitioner-led promotion of ACP in a convenience sample (n=120) of hospitalized patients with cardiovascular disease. In addition to the current practice, a nurse practitioner educated and encouraged patients to identify and document a HCP. Medical records of patients admitted prior to initiating the intervention (n=60) was compared to those receiving the intervention (n=60). HCP completion rate was the outcome of interest. A chi-square analysis was used to examine the effectiveness of the intervention. </span></p> <p style="text-align: left;"><span>Results: </span><span>There is significant relationship between NP intervention and new HCP completion (Chi-square = 86.769, df = 1, p < 0.05). Patients were more likely to complete HCP when there is an NP-led ACP intervention. Prevalence of HCP improved from 35% in controls to 90% in cases. </span></p> <p style="text-align: left;"><span>Implications: </span><span>Findings suggest nurse practitioners are effective in identifying and leveraging opportunities to facilitate ACP communication. Health care professionals are urged to empower patients to take full advantage of their self-determination. </span></p> </div> </div> </div>en
dc.language.isoen_USen
dc.rightsAn error occurred on the license name.*
dc.rights.uriAn error occurred getting the license - uri.*
dc.subjectHealth care proxyen
dc.subjectHeart Diseaseen
dc.subjectethical challengesen
dc.subjectEthical decision makingen
dc.subjectEnd of Lifeen
dc.subjectResuscitationen
dc.subject.meshAdvance Care Planningen
dc.subject.meshAdvance Directivesen
dc.subject.meshHeart Diseasesen
dc.subject.meshTerminal Careen
dc.subject.meshResuscitation Ordersen
dc.titleAdvance Care Planning in Patients with Heart Disease: A Practice Improvement Initiativeen_US
dc.typeDNP Capstone Projecten
thesis.degree.grantorStony Brook University, The State University of New Yorken
thesis.degree.levelDNPen
dc.description.noteThis work has been approved through a faculty review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.en_US
thesis.degree.year2015en
dc.type.categoryFull-texten
dc.evidence.levelCase-Control Studyen
dc.research.approachPilot/Exploratory Studyen
dc.author.detailsJaiby Joseph Augustine, DNP, RN, ANP-Cen
dc.subject.cinahlDecision Making, Ethicalen
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