Living Wills and Advance Directives: Closing the Gap
This paper examines the persistent gap in living will and advance directive completion among elderly and chronically ill patients. It identifies key barriers — including patient reluctance, staff overburdening, and inadequate institutional protocols — and proposes a targeted intervention led by a designated medical professional rather than nurses. The paper discusses appropriate settings for the intervention (hospitals, nursing homes, assisted living facilities, and home visits), evaluates it using both qualitative and quantitative methods, and outlines short- and long-term goals. Ultimately, the paper argues that proactive, structured conversations about end-of-life care documentation can benefit patients, families, and healthcare providers alike.
- Introduction: Why Living Wills Are Overlooked: Patients routinely decline living wills during hospital admissions
- The Case for a Targeted Intervention: Dedicated professionals should lead advance directive discussions
- Appropriate Settings and Designated Professionals: Hospitals, nursing homes, and home visits as intervention sites
- Evaluating the Intervention: Qualitative and Quantitative Methods: Observation and statistical analysis to measure effectiveness
- Short- and Long-Term Goals of the Intervention: More completed documents and clearer end-of-life care plans
- Conclusion: Empowering Patients Through End-of-Life Planning: Structured interventions benefit patients, families, and providers
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What makes this paper effective
- The paper clearly identifies a real-world clinical problem — the widespread failure to complete advance directives — and grounds its argument in recognizable healthcare settings and patient populations.
- It balances practical concerns (nurse workload, patient stress during admission) with policy-level thinking, making the argument feel grounded rather than abstract.
- The dual-method evaluation framework (qualitative observation plus quantitative statistical analysis) demonstrates methodological awareness appropriate for a health sciences paper.
Key academic technique demonstrated
The paper uses a problem-intervention-evaluation structure common in health promotion and nursing scholarship. It defines the gap (advance directives are not being completed), proposes a specific, feasible solution (a designated professional rather than overburdened nurses), and then articulates how that solution would be assessed and what success would look like — a logical chain that strengthens the argument's credibility.
Structure breakdown
The paper opens by framing the problem in the context of hospital admissions, then argues for a formal intervention rather than ad hoc conversations. It addresses where and by whom the intervention should be delivered, moves into evaluation methodology, and closes by distinguishing between short-term outcomes (more completed documents) and long-term outcomes (clearer end-of-life care for patients and families). Each section builds on the previous one, creating a coherent policy proposal.
Introduction: Why Living Wills Are Overlooked
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. When a patient goes to the hospital — either to be admitted or to use emergency services — he or she is often asked whether a living will is 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 rather than taught about other documentation.
Because of that reality, there must be a better way to reach elderly patients and those living with chronic conditions such as COPD. The proposed intervention would target these populations specifically. 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 appropriate venues. Another important setting is the home, especially when the services of a visiting nurse are already required.
The Case for a Targeted Intervention
While many people do not think about living wills, they are highly important documents for anyone who wants their wishes followed. The intervention may need to take place more than once, however, for people to fully understand the importance of this kind of document. Nurses or an appointed medical care professional would both be reasonable candidates to lead these conversations, but logically — and budgetary considerations aside — it would be better to designate a specific person for this role rather than asking nurses to handle it. Many nurses are already overburdened, and adding living will discussions to their workload would not benefit them or their patients.
A direct intervention is necessary because advance directives are not being completed upon admission to hospitals, doctors' offices, and other medical settings. This is especially true for elderly, chronically ill, and terminally ill patients. Findings from a focus group organized to address this issue confirmed that elderly patients, their families, and medical staff — including doctors, nurses, secretaries, case management clerks, admissions personnel, and ER triage nurses — do not routinely take the time to complete or discuss the importance of living wills. Hospitals and other medical care facilities must appoint someone other than the bedside nurse to speak with patients who do not have living wills during their stay.
Appropriate Settings and Designated Professionals
The intervention could take place across a range of healthcare settings. Hospitals remain the most logical choice given patient volume and the frequency with which end-of-life questions arise during admissions. However, nursing homes and assisted living facilities serve populations that are equally — if not more — in need of advance directive guidance, as residents in those settings are often managing chronic or terminal conditions on an ongoing basis.
Doctors' offices offer another important touchpoint, particularly for patients who are seen regularly for chronic conditions such as COPD, heart failure, or diabetes. A routine appointment can provide a calm, low-pressure environment in which a designated professional can raise the subject without the urgency or anxiety associated with an emergency admission. Home visits by a visiting nurse represent yet another opportunity, as the home setting may make patients more comfortable discussing end-of-life preferences than a clinical environment would.
Conclusion: Empowering Patients Through End-of-Life Planning
Even though it is a subject many people avoid, end-of-life care must be addressed. Elderly individuals and those living with chronic or terminal conditions must be made more aware of the importance of advance directives. When they do not have living wills, they leave their last wishes and their end-of-life care decisions entirely in the hands of others — decisions that may not reflect their true preferences.
A structured intervention could change that reality. By providing patients with clear information about living wills, offering follow-up opportunities to answer questions, and connecting them with the resources needed to create these documents, the intervention would help ensure that end-of-life care aligns with each patient's own values and desires. The benefits extend to families, nurses, and physicians alike, making this a meaningful and practical improvement to standard care practice.
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