Health Care Directives: Their Purpose, Understanding Nursing’s Role, and Developing a Meaningful Directive

Health Care Directives: Their Purpose, Understanding Nursing’s Role, and Developing a Meaningful Directive

Background: A major concern for many people receiving healthcare is being in a state of incapacity.  Whether this occurs at end-of-life or following an acute or traumatic incident, being unable to voice one’s wishes is a valid concern.  Advanced directives provide individuals with an opportunity to ensure their wishes are being met in such situations.  As the healthcare climate continues to increase in complexity as our population ages, the use of advanced directives has become common, and it is critical for nurses to have a clear understanding of the legal and ethical responsibilities when caring for patients making end-of-life decisions.  The purpose of this paper is to help those who are preparing to become Registered Nurses to develop a thorough understanding of what advanced directives are, the current legislation, what is involved in creating advanced directives, their advantages, limitations, and how the CNA’s Code of Ethics (2017), can facilitate this process.

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Purpose:

1. To provide an opportunity to explore the nature, usefulness, and difficulties associated with the completion of health care directives;
2. To become familiar with current legislation in Manitoba related to health care directives;
3. To understand the role of the nurse and how the CNA’s Code of Ethics (2017) guides nurses caring for patients with health care directives and when helping patients create advanced directives; and
4. To provide an opportunity to explore beliefs and values related to potential health crises and medical/health care treatments. 

Process Expectations:

1. Paper must adhere to all requirements of a student paper, APA 7^th edition, including an introduction and conclusion, appropriate use of headings, references, and title page.
2. Length: 8-10 pages, excluding title page, references, appendices. A minimum of 4 scholarly references to be included. 

Part A: Examination of Health Care Directives: Legal and Ethical Considerations and the Nursing Role

1. A brief discussion of what Health Care Directives are, and how they increase autonomy of a person receiving health care.  This section should contain two parts:
   1. Identify the purpose of advanced directives and describe how they serve to increase the autonomy of an individual.
   1. Discuss the benefits and limitations of Health Care Directives.
2. Provide a brief overview of the current legislation/requirements for Health Care Directives in Manitoba.
   1. Referring to the Health Care Directives Act of 1993, provide a brief overview of the components identified.  Please note that any interpretive statements of the Act provide only general information and does not include all relevant sections of the Act.
3. Describe the nurse’s role regarding advanced directives, including a brief description of how the CNA’s Code of Ethics for Registered Nurses (2017) can guide nurses in this process. Essay NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster GCU

Part B: Developing a Personal Directive:  Examining Values and Beliefs to Guide Development of a Meaningful Directive

1. Values Reflection: Provide a concise description/examination of the personal values and beliefs that will provide direction for your stated treatment wishes.
   1. These values are used to guide your decisions about what will provide you, personally, with quality of life.
   1. Include 3-5 core values that are the most significant to you and will provide a foundation for how you direct your care, as well as for those who would be following your directives instructions.  These values will provide the reader with a clear understanding of who you are as a person and what is most important to you and what will provide you with the most quality of life.The following questions from Winnipeg Regional Health Authority (2018) will help to provide a guide for your values reflection:
2. What do I value most in terms of my mental and physical health? (For example, being able to live independently, being able to recognize others, being able to communicate with others)
3. What would make prolonging life unacceptable for me? (for example, not being able to communicate with those around me, being kept alive with machines but with no chance of survival, not having control of my bodily functions)
4. When I think about death, I worry about certain things happening (for example, struggling to breathe, being in pain, being alone, losing my dignity, etc.)
5. If I were nearing death, what would I want to make the end more peaceful for me? (for example, family and friends nearby, dying at home, having spiritual rituals performed, etc.)
6. Do I have any spiritual or religious beliefs that would affect my care at the end of life? (for example, certain beliefs about the use of certain medical procedures)
7. Other wishes and thoughts (write down anything that would help others understand and support you at the end of life)
   1.  Identify a Substitute Decision-Maker/Proxy: Indicate who you choose as a proxy and explain what factors you have considered regarding your choice of a substitute decision-maker (i.e., why they would be an appropriate choice as an advocate for your care decisions).

Part C: The Health Care Directive: Attach a copy of your completed directive as an Appendix (per APA 7^th ed), detailing your treatment preferences.  The actual health care directive must identify:

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1. A designated health care proxy.
2. Treatment instructions and conditions under which the instructions are to be carried out [this will take careful thought, as you may wish some treatments in certain situations but not in others].
3. Consider discussion of areas such as use of ventilator support, feeding tubes, artificial hydration, cardiopulmonary resuscitation, organ transplantation. These are examples only. There must, however, be a clear connection made between what you value and the health care directive written.
4. It is not necessary, for purposes of the assignment, to activate the directive by signing and dating it at this time – this is your choice if you wish to retain a signed copy for your own purposes.