NURS 3325 Module 5 Discussion Advance Directives
NURS 3325 Module 5 Discussion Advance Directives
NURS 3325 Module 5 Discussion Advance Directives
Obtain both living will and a power of attorney documents from your place of work, the Internet, or other source.
It is often an awkward situation, in large part because many patients only see the advance-directives process in terms of suffering and death. That does not have to be the case.
“When physicians approach advance-care planning from the aspect of living well and quality of life, then patients feel reassured and then they want to engage with you and tell you what matters most,” according to internist VJ Periyakoil, MD, director of palliative care education and training at Stanford University School of Medicine.
Dr. Periyakoil wrote the “Planning for End-of-Life Decisions with Your Patients,” online physician education module.
The module is part of the AMA STEPS Forward™ collection of more than 50 practice-improvement education modules. It is part of the AMA’s strong support of advance directives and the help it provides to physicians on end-of-life matters, including guidance from the AMA Code of Medical Ethics.
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Medicare also has helped spur interest in advance directives, with payment starting in 2016 for every patient to have a voluntary consultation on the matter with a physician or qualified health care professional. This benefit has been widely used, with about 14,000 providers billing almost $35 million in the first year.
A recent review of 150 studies of advance directives found more than a third of Americans have them, in some form or another. That leaves a large majority—many with the most immediate need for advance directives—without written instructions that will protect their intentions or provide for trusted family or friends to make care decisions if they are unable.
A focus on what matters most
The CME credit-eligible module from the AMA is based on the Stanford University Department of Medicine’s Letter Project. The module’s central, downloadable element is a three-page letter template that in plain language guides the patient through expressing life values and goals, as well as care instructions such as palliative sedation.
The letter template is available in eight languages and written at a fifth-grade reading level. Patients can complete the letter by themselves or be aided by patient navigators or other clinicians. At Stanford, completed letters are scanned into the patient’s electronic medical record using a barcode.
Though not a formal advance directive or living will—those are governed on a state-by-state basis—the letter can be used as a worksheet to help patients express their wishes in simple language. A physician can include the letter in a patient’s medical record as patient-generated health data.
The module provides detailed advice about how to initiate the conversation. Dr. Periyakoil said her approach is to “normalize” the process by saying, “I ask this of all my patients.”
In that way, “patients don’t feel that they are singled out for this.” Her goal, she assures them, is “to provide you with the best possible care and to do that it really helps me to understand what matters most to you.”
Complete both documents, including obtaining witness signature. (If a notary public is required by your State law, locate one and record the location and cost of service. You do not need to actually have it notarized for this course.) Texas does not require them to be notarized. (Upload copies of the paperwork under the appropriate assignment)
Discuss your advance directives with the person you would like to make healthcare decisions for you. If you have no one, discuss with a classmate or coworker.
Include a citation to the site where you retrieved your advance directive (if you obtained it online) or from your reading on advance directives. It does NOT have to be in APA format. Just explain where you obtained the form
For the discussion:
How difficult was it to find these forms?
Do you feel they are important for an older adult to have?
Would an older adult need help finding them? completing them?
Has this assignment made you change your opinion regarding advance directives?