Advance directives and the Patient Self-Determination Act

Advance directives and opportunities for nurses

Technical, social, and economic factors are an impetus for expressing end-of-life decisions as advance directives (ADs) including a living will and durable power of attorney. Despite opportunities, nurses do not appear to be widely involved in practice and research regarding ADs. To provide perspectives for nursing participation, the literature was reviewed, and a set of outcomes regarding ADs were identified. The historical background and the ethical issues associated with ADs are examined. Appropriate roles for nurses with respect to ADs are suggested. Research and practice opportunities are identified. The databases reviewed were the Cumulative Index to Nursing and Allied Health Literature from 1983 to January 1996, and MEDLINE, from 1985 to January 1996.

Implementation of the Patient Self-Determination Act: a survey of Nebraska hospitals

The purpose of this survey of Nebraska hospitals (N = 79) was to describe the planning, implementation, and evaluation of the Patient Self-Determination Act (PSDA) and to explore the role of the nurse in these processes. Results indicate nurses were very involved in the planning phase but rarely in the implementing phase. Few evaluation strategies were utilized and only some respondents identified problematic issues related to the implementation of the PSDA. Clinical implications for issues related to the PSDA are discussed and framed within the American Nurses' Association Position Statement on the PSDA (1991). Future studies are suggested, especially related to evaluation of PSDA implementation.