The Advance Health Care Directive
When investigating the topic of palliative care, I downloaded the Advance Health Care Directive (AD) for Florida from the official website where relevant documentation for all states was collected (National Hospice and Palliative Care Organization, 2017). The information presented is consistent with existing legislation and provides an opportunity for patients to make essential decisions concerning their health. For instance, the AD includes the possibility of assigning responsibility for individual actions to another person, drafting a document on voluntary organ donation, and other significant decisions that are relevant among gerontological patients.
Based on the state law of Florida, an appropriate form can be compiled and distributed to various individuals, including relatives, lawyers, and other stakeholders. It is important to note that, according to National Hospice and Palliative Care Organization (2017), the AD will not have legal force in case of a medical emergency since special assistance measures are required, in particular, cardiopulmonary resuscitation (CPR). However, in the standard care environment, the AD allows patients “to document the type of care they would like to receive if they are unable to express their wishes” (Portanova, Ailshire, Perez, Rahman, & Enguidanos, 2017). Thus, it is similar to insurance that helps to protect the interests of those who have certain preferences regarding care and treatment outcomes.
It was not difficult to complete the AD since all the data are described in detail, and specific tips are given to include the information that is needed. However, from the point of view of personal evaluation, it can be noted that some terms are serious enough, and patients may experience discomfort when signing such a paper. For example, the statement “organs, tissues, or eyes for the purpose of transplantation, therapy, medical research, or education” is rather scary (National Hospice and Palliative Care Organization, 2017, p. 9).
Also, individual difficulties may arise in some people who complete the AD. Portanova et al. (2017) argue that religious beliefs can influence patients’ opinions regarding particular terms. Therefore, the participation of medical personnel is necessary in order to monitor and support complex decisions.
Physician Orders for Life-Sustaining Treatment (POLST) Form
The Physician Orders for Life-Sustaining Treatment (POLST) form is the document that includes information about the individual preferences of a particular patient regarding his or her end-of-life treatment. According to the National POLST Paradigm (2018), this form contains three main sections (cardiopulmonary resuscitation, medical interventions, and artificially administered nutrition) and additional parts with signatures.
The document is usually completed by adult patients who may be offered this procedure after conversations with their physicians or other medical specialists. As a rule, in case of an illness or a severe condition, this form can be the confirmation of people’s individual preferences regarding the characteristics of medical and nursing procedures provided. It means that only after a personal request, such a form can be provided, and coercion is unacceptable.
In order for the document to be valid, it is significant that not only the patient signs it but also a healthcare professional; otherwise, the form will be invalid. “The physician’s signature authenticates the POLST form into actionable physician orders, which then can be followed by other health care providers at any location at any time” (McGough, Hauschildt, Mollon, & Fields, 2017, p. 22). Instead of a patient, his or her surrogate may sign this form. Thus, several stakeholders are involved, which confirms the validity and legal force of the form.
Summary and Conclusion
In terms of palliative care, both the advance directive and the POLST form are important documents that enable patients to receive those conditions of nursing care and treatment that they want. Despite the fact that papers are signed to confirm personal preferences, these two types of medical documents are not identical and have differences. In particular, the advance directive contains a wide range of points and includes not only the type of care but also optional offers, such as organ donation.
In the POLST form, these details are not available, and exclusively end-of-life care is listed to receive the patient’s opinions. Also, McGough et al. (2017) note that these two documents are different in appearance, and it is not difficult to distinguish from each other. Therefore, despite many similar properties, for example, their uniqueness in each state, the advance directive, and the POLST form have some different features.
The role of registered nurses in assuring the patient’s right to autonomy in choosing specific healthcare interventions is significant. According to Tobiano, Bucknall, Marshall, Guinane, and Chaboyer (2015), junior medical employees help people understand the characteristics of certain treatment methods, give them relevant knowledge, and are directly involved in the end-of-life care process.
Moreover, since registered nurses are involved in almost all the stages of working with patients, they often hold conversations with those who plan to complete either the advance directive or the POLST form. Therefore, medical specialists help patients to be aware of the features of these documents and stimulate their confidence that any individual preferences and requests are to be observed on the basis of the signed papers.
References
McGough, N. N., Hauschildt, B., Mollon, D., & Fields, W. (2015). Nurses’ knowledge and comfort levels using the Physician Orders for Life-sustaining Treatment (POLST) form in the progressive care unit. Geriatric Nursing, 36(1), 21-24. Web.
National Hospice and Palliative Care Organization. (2017). Florida. Advance directive. Planning for important health care decisions. Web.
National POLST Paradigm. (2018). POLST paradigm form elements. Web.
Portanova, J., Ailshire, J., Perez, C., Rahman, A., & Enguidanos, S. (2017). Ethnic differences in advance directive completion and care preferences: What has changed in a decade? Journal of the American Geriatrics Society, 65(6), 1352-1357. Web.
Tobiano, G., Bucknall, T., Marshall, A., Guinane, J., & Chaboyer, W. (2015). Nurses’ views of patient participation in nursing care. Journal of Advanced Nursing, 71(12), 2741-2752. Web.