I obtained my Advance Directive at an acute care hospital in the state of California. In this state, Advance Health Care Directives are legal documents detailing the desires of a person regarding their health, should they become unable to make such decisions. California does not recognize the term living will, meaning that only Advance Healthcare Directives can be used to designate proxy care of a person (Uniform Health Care Decisions Act, 1999). Advance Directives in California can be given orally or in a written form and can be limited to only come into effect under specific circumstances, as defined by the individual. However, the Advance Directive requires an adult witness that is not associated with the individual’s healthcare provider (Uniform Health Care Decisions Act, 1999). The patient can specify in which cases their life should be prolonged or not prolonged as well as determine what cases would be unbearably painful to the patient. California law also prohibits health care providers and insurers from denying health care because of an Advance Directive. Overall, California law regarding Advance directives is relatively similar to most US state laws on this topic.
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Moreover, the majority of California residents have not set up Advance Health Care Directives. Only 23% of the state population has a filled out and completed, as detailed in the previous paragraph, their Advance Directives (Koeppenn et al., 2017). In general, most Californians have not consulted with a health care specialist about end-of-life care, with only 7% reporting that they have spoken with a doctor about the subject. California does not have protocols or laws directing health care providers to discuss and plan end-of-life care and Advance Health Care Directives with patients (Koeppenn et al., 2017). Advance Health Care Directive can be filled out by mail in the state of California, but few residents have used this opportunity. Overall, California laws regarding Advance Health Care Directives are clear and understandable; nevertheless, the public lacks awareness of the actual process.
Furthermore, filling my Advance Health Care Directive was difficult as the decisions required by the form seem daunting, particularly when defining if I want my life prolonged. This is in line with research on the topic where uncertainty about the possible context of a medical issue limits an individual’s clarity on the subject (Schröder et al., 2016). I also had difficulty when considering the weight of an Advance Directive, as it could overrule the medical knowledge of my future health care provider. This is a common concern among people creating Advanced Directives and comes from the perception that medical knowledge might shift after the Advanced Directive is made (Schröder et al., 2016). Deciding whether I would approve pain management if it might impair my consciousness and mental ability was difficult. The form required me to make a blanket judgment on a topic with many potential outcomes, which was stressful. This anxiety and uncertainty have been found to limit Advance Directive completion (Schröder et al., 2016). In contrast, the legal requirements were not challenging to understand, and from a bureaucratic standpoint, filling out the Advance Health Care Directives was simple.
Physician Orders for Life-Sustaining Treatment (POLST) Form
The Physician Orders for Life-Sustaining Treatment (POLST) is a patient-oriented communication strategy that allows patients and health care specialists to engage in discussions concerning end-of-life treatment. The central point of the POLST model is a planning form designed to express the desires of severely ill patients and their inclinations for life-sustaining medical care (Russell, 2016). Literature suggests that the POLST form is more efficient at communicating each patient’s likings than conventional advance directives (Russell, 2016). The POLST form is indicated to be a planning instrument to promote patient-provider dialogue about care possibilities. A health care specialist can refer to the POLST form as an overseen source for plan creation and development rather than being expected to generate a unique communication approach. Overall, the POLST model considers several of the existing constraints of conventional advance orders by offering a standardized form that registers patient therapy and medication partialities into medical orders.
The POLST form should be completed when a seriously ill or weak patient needs to be given more specific control over their health care treatments. Additionally, the patient’s completed form should be reviewed when an individual is transferred from one medical setting to another. Furthermore, a significant change in the patient’s health status must require a supplementary revision. Thus, the completion of the form rests upon the physical and mental needs of the patient, and the potential modifications depend on the individual’s health alterations and added desires.
Moreover, POLST form completion should always be treated as voluntary and must never be ordered. Moreover, completing a POLST form without awareness and consideration with the patient or surrogate is irreconcilable to the design and purpose of POLST. Therefore, it would violate informed approval and central postulates of the patient and family-centered treatment (National POLST, 2020). The POLST form is composed to document particular care arrangements established after a consensus-oriented process of decision-making between a patient and a health care expert. The official POLST signature requirements doctrine for a legitimate form states that “Patients should never be given a POLST form and asked to fill it out” (2020, p. 2). Overall, both parties should participate in the completion of the form for it to be valid.
Lastly, the POLST form is considered a medical order and needs to be signed by a physician (MD or DO), nurse practitioner (NP, APRN, ARNP), and physician assistant (PA). Thus, all parties should sign the form for it to be legitimized, based on California state law. Each form has a record or attestation with the required health care specialist’s signature to register the orders that reflect the patient’s care preferences (National POLST, 2020). Additionally, the California state expects the patient or their surrogate to sign the form to indicate their understanding and compliance with the orders noted on the form (National POLST, 2020). Therefore, the form becomes a binding agreement between a health care provider and a patient after all parties sign the POLST.
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Summary and Conclusion
To sum up, the POLST can be seen as a continuation of an Advance Health Care Directive; however, it is primarily designed for patients who consider themselves seriously ill. Furthermore, while Advance Health Care Directives in California may contain specific conditions that must be met for it to come into effect, these directives, in general, are somewhat standard. A POLST, in contrast, is much more specific and can only be created through conversation and consensus with a health care specialist. Unlike an Advance Directive that can take the shape of a mailed-in form, a POLST is the result of a dialogue between a doctor or specialist and a client.
Due to this condition, a POLST is likely to have significantly more specific requirements and needs regarding the patient and their treatment. This allows the patient to feel more confident about how they might be treated in an emergency. As a result, the person might not go through many of the difficulties associated with filling out an Advance Directive, such as stress and uncertainty (Schröder et al., 2016). Overall, a POLST can be an essential and beneficial supplement to an Advance Directive, particularly for patients with severe illnesses.
In conclusion, the Registered Nurse (RN) plays an essential role in securing the patient’s independence while choosing individual care interventions. In the instances of both the Advance Health Care Directive and the POLST, health care specialists, including RNs, should ensure the patient’s autonomy throughout the decision-making processes. Physicians and nurses are not legally allowed to make binding decisions between a provider and a client without a patient’s direct consideration and input. In the case of the POLST form, only several states do not require a mandatory signature from a patient (National POLST, 2020). However, the national POLST guidelines still suggest that healthcare providers must ensure a patient has thoroughly read and approved the form (2020). Patient-centered care and treatment experts should be particularly sensitive to clients’ freedoms during every stage of their lifespan. Therefore, RNs are crucial for assuring every patient’s autonomy, as it is equally fundamental for the Advance Health Care Directive and the POLST.
Koeppenn, E. S., Burkard, J., & Ward, E. (2017). Improving advance directive completion rates through advance care planning (Publication No. 57) [Doctoral dissertation, University of San Diego]. University of San Diego Database.
National POLST. (2020). Signature requirements for a valid POLST form by state. Web.
Russell, J. (2016). The role of health care provider goals, plans, and physician orders for life-sustaining treatment (POLST) in preparing for conversations about end-of-life care. Journal of Health Communication, 21(9), 1023-1030. Web.
Schröder, L., Hommel, G., & Sahm, S. (2016). Intricate decision making: Ambivalences and barriers when fulfilling an advance directive. Patient Preference and Adherence, 10, 1583–1589. Web.
Uniform Health Care Decisions Act, Publ. L. No. 4670 – 4743 (1999). Web.