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Running head: ADVANCED DIRECTIVE VS. POLST

ADVANCED DIRECTIVE VS. POLST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Advanced Directive vs. POLST

Jodi Turco, RN

December 2, 2019

 

 

 

 

 

 

 

 

 

 

 

 

 

Florida laws around advance directives are found in chapter 765 of Florida Statutes and split into three types: living wills, health care surrogate designation and anatomical donations. Each can be completed separately, but that would be redundant. The definition according to Florida Statutes is, “Advance directive” means a witnessed written document or oral statement in which instructions are given by a principal or in which the principal’s desires are expressed concerning any aspect of the principal’s health care or health information, and includes, but is not limited to, the designation of a health care surrogate, a living will, or an anatomical gift made pursuant to part V of this chapter” (2018). I obtained a copy of an advance directive form from the registration department of the facility that I work in and filled it out. It was straight forward and vague in that it says, “I direct that life-prolonging procedures be withheld or withdrawn when the application of such procedures would serve only to prolong artificially the process of dying” in the living will section and goes on to designate a surrogate. The second page is the Designation of Health Care Surrogate which states, “I fully understand that this designation will permit my designee to make health care decisions and to provide, withhold, or withdraw consent on my behalf”. It further designates a second surrogate as an alternate. The final page is the Uniform Donor Form which indicates whether or not a person wants to donate their organs or tissues for donation to others who need it or for research purposes. All of the forms require witnesses to be put into effect, but the Living Will and Health Care Surrogate forms require witnesses that are not blood related or the spouse of the person. To comply with Florida and Federal Laws, there are accompanying pages that explain the compliance requirement to provide a copy of a blank advance directive to each patient but ensure them that their care is not dependent upon the completion of the forms. Also attached are explanations and/or limitations of each. Of note is that there is a separate form needed if a patient wishes to not be resuscitated from a cardiac arrest. That form is a Do Not Resuscitate Order (DNRO) and must be completed by a physician. There were some odd feelings stirred up in me while I filled out the forms. The Living Will is tough to do because it makes you think about the end of your life, which is extremely uncomfortable to think about. It also asks you to think of the people that you’d trust to uphold your wishes in the event that you’re incapacitated. I couldn’t help but laugh at the fact that I struggled to choose two people in my life that I’d trust with those choices, but I think that maybe that is because no one in my family has a medical background to understand the processes of diseases or death to ask the questions that you or I would. It also made me thankful that my father had a living will in place when he passed away. I remember being comforted by the fact that we knew removing life-support was what he would have wanted. The organ donation form is a no-brainer for me, as I have been a donor since I was old enough to make the decision for myself. I have had the discussion with my family that I would like to have my body donated to those in need or to science to provide education to the next generation of medical professionals.

Meyers et al. state, “The Physician Orders for Life Sustaining Treatment (POLST) form provides choices about end-of-life care and gives these choices the power of physician orders” (2004). Florida does not have a statewide POLST program, but if a person is facing a serious illness they can inquire with their doctor or treating medical facility about completing one. A POLST form differs from a DNRO in that it expands upon life-sustaining measures such as feeding tubes and hydration. It is meant to be used in conjunction with, not as a substitute for a Living Will and is also a part of a patient’s medical record that can be transferred from facility to facility to ensure continuity of care.

I work in an emergency department where lifesaving interventions are an everyday occurrence. The term “a good death” was coined by the Institute of Medicine with the meaning “one that is free from avoidable distress and suffering, for patients, family, and caregivers; in general accord with the patients’ and families’ wishes; and reasonably consistent with clinical, cultural, and ethical standards.” The importance of understanding end-of-life documents is critical to my practice. The POLST form is one that my state does not provide, but I believe would be an important adjunct to the living will now that I see how vague it really is. The POLST is most appropriate for patients that have serious illnesses as it helps loved ones to understand the details of a patient’s wishes. It makes communication amongst the varying disciplines more seamless. An advance directive is composed of two parts (or three in Florida): an advance directive, the designation of a health care surrogate, and an option to donate organs. A living will discusses the preferences of a patient to whether or not they want to receive pain medication, antibiotics, food or water at the end of life. It differs from the POLST form because it is filled out in a hypothetical scope. It is also not legally binding like an advance directive is. End-of-life decisions are not comfortable to make by any means, but this assignment brings to light the importance of these documents. Having conversations with our patients about these forms and being able to communicate the reasons for them is a vital part of a nursing career. They can also put patients at ease knowing that their loved ones will not have to make tough decisions in the event that they become incapacitated. They also help start a dialogue with patients and families about end-of-life wishes.

 

 

 

 

 

Reference

(n.d.). Chapter 765 – 2018 Florida Statutes – The Florida Senate. Retrieved December 4, 2019a,

from https://www.flsenate.gov/Laws/Statutes/2018/Chapter765/All

 

Kellogg, E. (2017). Understanding Advance Care Documents: What the Nurse Advocate Needs

to Know. Journal of Emergency Nursing, 43(5), 400–405. Retrieved December 4, 2019, from 10.1016/j.jen.2016.12.001

 

Meyers, J. L., Moore, C., McGrory, A., Sparr, J., & Ahern, M. (2004). PHYSICIAN ORDERS

for Life-Sustaining Treatment Form: Honoring End-of-Life Directives for Nursing Home Residents. J Gerontol Nurs, 30(9), 37–46. Retrieved December 4, 2019, from 10.3928/0098-9134-20040901-08

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