Masters Theses

Date of Award

5-1999

Degree Type

Thesis

Degree Name

Master of Science in Nursing

Major

Nursing

Major Professor

Debra C. Wallace

Committee Members

Joan Uhl Pierce, Mary Anne Modrcin-Talbott

Abstract

The Patient Self-Determination Act was introduced to support autonomy through the use of Advance Directives (ADs), in hopes of ensuring people a more compassionate and dignified death, yet use of a living will or healthcare power of attorney remains low, 15-20%. One inherent limiting factor in AD implementation appears to be lack of patient-provider communication, reportedly due to healthcare professionals' discomfort raising such issues. Since nurses are the largest group of healthcare professionals, the future responsibility for initiating AD conversations may likely fall to them.

According to Johnson's Behavioral System Model, nurses use themselves as a primary resource when assisting patients to recognize alternative choices. However, research shows that nurses are not very different from the general population regarding AD implementation. This non-experimental study explored responses of a random sample (N = 131) of Tennessee Registered Nurses (RNs) regarding how their personal CHOICES were related to professional ACTIONS concerning AD implementation. Results from a mailed self-report questionnaire, "Your Views On Advance Directives", indicated that while RNs overwhelmingly support ADs, the majority had not personally implemented one.

Significance related to having implemented ADs were older age, more years of RN experience, implementation of an Estate Will, and past experience withholding a patient's life-sustaining treatment. Significant reasons for lack of discussions with family or physicians concerning end-of-life wishes included: Subject never came up and current state of health did not warrant it. Inconsistencies existed between what the RNs' believed professional responsibilities should include and what their current activities were regarding counseling, educating, and assisting patients with ADs.

Findings support that nurses' personal CHOICES and ACTIONS are similar to the general population; while professionally, they do not differ much from other healthcare providers. Results highlight several areas for educational interventions aimed at nurses including: Emphasizing mandated nursing responsibilities regarding counseling, educating, and assisting patients with ADs; stressing that ADs are not only for the old and sick; and reinforcing the benefits of discussing end-of-life wishes with family and physicians. By first addressing their own personal CHOICES and ACTIONS concerning ADs, nurses may become effective resources for patients and other health team members.

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