Living wills and advance healthcare directives

Living Wills

All too often, living wills are something "swept under the rug" by patients who need them and by those who could help patients set them up and get them in place. When a patient goes to the hospital, either to be admitted or to use emergency services, he or she is often asked if there is a living will in place. Often, the answer is "no," and when asked whether he or she would like to create one, the answer is still "no." There is too much stress in a situation like that, and the person wants to be treated for his or her immediate problem, not be taught about other documentation. Because of that, there must be a better way for a person who is elderly and/or who has a chronic condition. The proposed intervention would involve the elderly and those who live with chronic issues such as COPD. The intervention could take place at one of several locations. The hospital is the most logical choice for a discussion of living wills, but nursing homes, assisted living facilities, and doctors' offices are also good choices for discussing living wills. Another important place to discuss these documents is in a home setting, especially when the services of a visiting nurse are required.

While many people do not think of living wills, they are highly important documents for those who want their wishes followed. The intervention may need to take place more than once, however, for people to understand the importance of this kind of document. With an intervention such as this one, the nurses or an appointed medical care professional would both be good choices as to who should be designated to address the issue. Logically, and budgetary issues notwithstanding, it would be a better choice for a specific, designated person to discuss the living will, as opposed to asking nurses to handle the issue. Many nurses are already overburdened with the work they do, and adding living will discussions onto their workload would not benefit them or their patients.

A direct intervention with a visiting nurse or other medical professional is necessary because living wills, or advance directives, are not being completed upon admission to hospitals, doctors' offices, and other medical arenas This is especially true for the elderly and chronic or terminally ill patients. From the focus group that was organized to address the issue, it was learned that the elderly, patients and their families, and doctors, nurses, secretaries, case management or admissions clerks, ER triage nurses, and others in a medical setting do not take the time to complete or teach about the importance of living wills. Nurses do not have the time to address the needs of patients when it comes to living wills. Hospitals and other medical care facilities must appoint someone other than the nurse to speak with patients who do not have living wills during their hospital stay.

This intervention must be evaluated with qualitative and quantitative methods in order to ensure it is working correctly. If there are problems with the initial intervention, there are opportunities to adjust it - but only if the reasons behind the problems can be discovered. A qualitative method that could be used with this intervention is observation. The desire would be to see how many people were "swayed" by what they were told regarding living wills. If a patient was provided information about living wills properly, would that patient decide to create a living will for himself or herself? Would the results of that style of intervention be any different than the results of the current (lack of) intervention that is taking place in hospitals and other medical facilities in the present day? That is a question that cannot be answered without study, but qualitative methods do not necessarily provide enough data to make an accurate assessment.

Another way to assess the intervention is to use quantitative methods. One of the most popular of these types of methods is the survey or questionnaire. However, it can become difficult to use this method on elderly individuals in the hospital and other medical facilities. The best way to measure the intervention quantitatively is through a statistical analysis of whether people are more likely to create a living will after they have been visited by the designated medical professional. If the difference is statistically significant and other variables can be controlled for, the intervention could be seen as having value for those who need information about living wills and are currently not getting that from their interactions with medical professionals. If the intervention is successful, there will be both short-term and long-term goals that will be met, as well. Short-term goals include the creation of more living wills and advance directives, which helps hospitals, doctors, and patients all be more prepared for the inevitability of aging individuals.