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Implementing advance directives : an international literature review of important considerations for nurses
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AIM(S): A review of the global literature on the implementation of Advanced Healthcare Directives to date, and of the experiences of the healthcare professionals who must initiate the discussions around advance care planning, as well as support patients' ultimate decisions.
BACKGROUND: Ireland's Assisted Decision-Making (Capacity) Act 2015 legalises Advance Healthcare Directives. It promotes the autonomy of the person and enables them to have treatment in accordance with their will and preferences. However, there is professional uncertainty on how to support and integrate assisted decision-making.
EVALUATION: 16 studies featuring the views of healthcare professionals are included and evaluated using a framework of 'benefits versus challenges'.
KEY ISSUE(S): Four themes clearly emerge during the review process: the concept of capacity and who decides; autonomy vs paternalism - conflict among the healthcare professional/patient/family-carer triad; barriers to advance directives; and timing issues.
CONCLUSION(S): Significant benefits of advance healthcare directives exist for all parties including less stress for patients and families alike, less burden and less residual guilt for surviving relatives, and an over-arching prevention of 'crisis' decision-making.
IMPLICATIONS FOR NURSING MANAGEMENT: This review highlights the central role of the nurse in empowering patients to express their wills and preferences, supporting patients' capacity to make decisions about their own care, initiating end-of-life care discussions and advocating to have advance healthcare directives acknowledged. Moreover, it identifies the challenges ahead for all nurse managers in implementing this new mandate.
http://dx.doi.org/10.1111/jonm.13097
Voir la revue «Journal of nursing management»
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