Advance care planning in patients with heart disease: A practice improvement initiative
View File(s)
Visitor Statistics
Visits vs Downloads
Visitors - World Map
Top Visiting Countries
Country | Visits |
---|
Top Visiting Cities
City | Visits |
---|
Visits (last 6 months)
Downloads (last 6 months)
Popular Works for Augustine, Jaiby Joseph by View
Title | Page Views |
---|
Popular Works for Augustine, Jaiby Joseph by Download
Title | Downloads |
---|
View Citations
Citations
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.
Proposing a Practice of Advance Care Planning by Nurse Practitioners to Prevent Futility and Alleviate Unnecessary Human Suffering at End of Life.
This work has been approved through a faculty review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.
Type | DNP Capstone Project |
Acquisition | Self-submission |
Review Type | Faculty Approved: Degree-based Submission |
Evidence Level | Case-Control Study |
Research Approach | Pilot/Exploratory Study |
Keywords | Health Care Proxy; Heart Disease; Ethical Challenges; Ethical Decision Making; End of Life; Resuscitation |
CINAHL Subject(s) | Decision Making, Ethical; Advance Care Planning; Advance Directives |
MESH Subject(s) | Heart Diseases; Terminal Care; Resuscitation Orders |
MESH Subject(s) | Heart Diseases; Terminal Care; Resuscitation Orders |
Grantor | The State University of New York at Stony Brook |
Advisor | Shurpin, Kathleen M. |
Level | DNP |
Year | 2015 |
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
All permission requests should be directed accordingly and not to the Sigma Repository.
All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Related items
Showing items related by title, author, creator and subjects.
-
Effects of advance care planning intervention on end-of-life decision making
Kim, Minju; Lee, JieunThe purpose of this study was to systematically review reports of published randomized controlled trials to ascertain the effectiveness of an advance care planning intervention. -
Challenges in advanced care planning in primary care: A systematic review
Willson, Pamela; Gondran, Sue EllenThe greatest obstacle to Advance Care Planning (ACP) is initiating the difficult conversation about death and planning for the end that is culturally sensitive and patient-centered. Poor end-of-life communication skills, ... -
The relationship between perceived quality of life and attitudes toward advance directive decisions in older adult nursing home residents
Pence, Patricia L.The purpose of this study was to examine the relationship between the perceived quality of life and attitudes toward advance directive decisions based on the resuscitation status of older adults who resided in nursing ... -
Proxy decision-making and dementia care: Exploring decision-makers' thinking using construal level theory
Convey, Helen M.; Holt, Janet; Summers, Barbara (2017-06-06)Purpose: Dementia is a syndrome which affects the individual’s ability to make decisions and to undertake everyday activities (ADI, 2015; WHO, 2012). A range of neurodegenerative diseases (including Alzheimer’s ... -
Deciding to engage in advance care planning: A comparison of participants' experiences
Vander Laan, Karen J.Advance care planning (ACP) is a dynamic decision-making process that assists people to construct and communicate their preferences for end of life care. Two decades of research have shown that when preferences are not ...