See handout for complete reference list the host Mor Advanced Directives in the Intensive Care Unit Deidre Dennison, RN State University of New York Institute of Technology Project/InterventionEvidence Conclusion Abstract References Acknowledgements Thanks to Deb House, MSW for the education regarding health care proxy process in NYS as well as for being a wonderful patient advocate PICO Question: In intensive care patients, what is the effect of having completed advanced directives paperwork on honoring patient’s wishes in regard to care, compared with no advanced directives, or a surrogate decision maker assigned by the institution? The purpose of this project was to explore the effect that advanced directives have on patient care, as well as to take the opportunity to discuss advanced directives with patients and families. Utilizes Jean Watson’s Human Science & Human Care Theory To utilize the ‘Health Care Proxy’ form on the existing ‘Consent to Treat’ as a way to initiate conversation regarding advanced directives with appropriate vascular surgical intensive care patients Encouraged open dialogue regarding advanced directives Provide support and education to patients and families regarding advanced care planning Chart audited daily for evidence of health care proxy/advanced directives Patients without proxies were evaluated for ability to assign a proxy in the setting/condition Most patients do not have pre-drafted advanced directives Many patients willing to discuss, but only successfully completed half of appropriate patients The Patient Self-Determination Act (1991), allows individuals to make future health decisions or appoint a proxy to make decisions Ideally discussed prior to hospitalization or illness, during a well-visit Nurse-run seminars in the community may be helpful Limits include vague terminology, unwillingness of family/patient to produce paperwork, disagreement among family members Benefits include creating an opportunity to discuss end-of-life planning, and quality of life discussions A way to shift end of life planning from the proxy to the patient by “honoring patient’s wishes” Overall consensus from the literature is that current advanced directives are limited Best way to honor the patient’s wishes is to have frequent and open conversations with loved ones and providers Cultural considerations should be made in regard to decision making Advanced directives are limited in both use and applicability in their current form Nurses are in a unique position to initiate conversations regarding advanced care planning, end-of-life, and quality-of-life Ideal setting for advanced directives discussions are in primary-care settings, prior to major illness or hospitalization The best way for patient’s wishes to be honored is through open conversations between the patient and health care proxy about future wishes Results regarding prevalence of advanced directives were consistent with evidence Patient education /discussion regarding advanced directives is an ongoing conversation Watson’s theory promotes unity between body, mind, and soul. Advanced care planning is a way to direct care in a manner congruent with the patient’s vision of “self”