Faculty member Donna Helen Crisp, JD, MSN, RN, CS, recently published an article in the March issue of the Journal of Nursing Law, entitled “Healthy Older Adults’ Execution of Advance Directives: A Qualitative Study of Decision Making.”
This study looks at why people who choose to create a Living Will or Health Care Power of Attorney arrive at the decision to do so. The research also makes recommendations for nursing practice as related to patients’ Advance Directives (ADs).
To gather data, Crisp interviewed eight healthy older adults, ranging in age from 60 to 77, over a four-month period. All participants were white. Three were men, and five were women. All participants were interviewed for 30 minutes to 50 minutes.
Through her research, Crisp discovered that there were three major influences that prompted people to draw up ADs – family influences (such as watching a loved one die); quality-of-life concerns (such as loss of autonomy and dignity); and pragmatic concerns (such as drain of financial resources). Participant interviews revealed, however, that there was no one overriding reason why people decide to obtain an AD.
Crisp’s study also offered comments on attorney-client end-of-life planning. In her interviews, she found that the participants were more influenced by discussions with their attorneys over matters, such as estate planning, than by talking with a doctor. Her review of a Veterans’ Affairs study saw more people completing ADs after talking with a lawyer.
The study showed that nurses can play a specific and unique role in their patients’ understanding of ADs as they shepherd patients and families through an informed and sensitive conversation about end-of-life care and the decision-making required to ensure patients’ wishes are honored. Because of the intimate care nurses give to patients, they are often the most effective facilitators of such discussions, especially when it is clear that medical intervention will no longer be effective.