Nurses: Who Will Speak for Your Patient?
Guest Post
By Cynda Hylton Rushton, PhD, RN, FAAN, Johns Hopkins School of Nursing; & Virginia Tilden, RN, DNSc, FAAN, College of Nursing, University of Nebraska Medical Center
April 16 is (and has been since 2007) National Healthcare Decisions Day (NHDD). NHDD is a day to mark the week for all adults to mark their calendars, have the talk, and document the talk with an advance directive.
What talk?
The talk that someone has about the care they want during a serious, life-limiting or advanced illness.
Experiencing advanced illness can be an emotionally charged time of life when people (patients, families and health professionals) struggle with difficult decisions with little support or guidance. Its all the more important, then, that we as clinicians understand what the person who’ll receive the care wants.
We know that nurses have long had a critical role in ensuring that care for those with serious, progressive illness is both person-centered and compassionate. A recent poll released by the National Journal showed that a significant majority (60 percent) of physicians think that nurses and other health professionals provide excellent care during advanced illness. (By comparison, just under half (49 percent) of physicians thought their own profession excelled in care during this time of life). So, what can we — as nurses — do to help some of the most vulnerable and sickest in our society find their voice?
The first step is easy: watch this 3 minute video from NHDD: http://www.nhdd.org/
The second gets a little technical: let the person and his/her family know about the healthcare power of attorney, sometimes also referred to as a “health care proxy”.
As you saw in the NHDD video, a number of health crises (a coma or advanced stage condition such as cancer or Alzheimer’s) can hamper your ability to speak for your self. When we think of patients and families, it’s vitally important that we know who the decision maker will be.
Think about this:
The person you’re caring for has had a stroke and can’t communicate. Her son will be at the hospital shortly; her daughter is from out of town and flying in the next day. Both are legally entitled to speak and act on behalf of their mother. What do you do when the son arrives? What would you do if he disagrees with his sister regarding the course of treatment? Who will speak for your patient?
We understand that disagreements do occur and that the best way to address them is before a health crisis – by having the talk. But the talk isn’t enough. You also have to record it in an advance directive, which names and authorizes the person of your choosing to make health care decisions for you in the event that you are unable to speak for yourself.
The third step is to share an advance directive form with the person and family. You can find the forms here. Once it’s filled out, encourage the person to share it with family, loved ones, and medical staff. Note that the person who is the substitute decision maker must agree to serve in this role and to keep their copy of the advance directive where they can access it
We are working with the Coalition to Transform Advanced Care (C-TAC) to promote and, where appropriate, develop resources that will help nurses and other members of the inter-professional care team provide person-centered care. And person centered care starts with understanding what it is the person – not patient – in front of us wants: what are your goals and values?
The results might surprise us.
Find out more about NHDD (below) and how you can help get the word out: who will speak for your patient?
About the Authors
Cynda Hylton Rushton PhD, RN, FAAN is a Professor in the Nursing & Pediatrics at Johns Hopkins University; Core Faculty, Berman Institute of Bioethics and Program Director with Harriet Lane Compassionate Care. Cynda also serves as Co-Chair of C-TAC’s Professional Education workgroup and on C-TAC’s Board of Directors.
Virginia Tilden, RN, DNSc, FAAN, is Dean and Professor Emerita at the College of Nursing, University of Nebraska Medical Center. Virginia also serves in C-TAC’s Professional Education workgroup.
About National Healthcare Decisions Day
Now in its 5th year, National Healthcare Decisions Day (NHDD) exists to inspire, educate and empower everyone – regardless of age or health status – about the importance of advance care planning and to encourage individuals to express their wishes regarding their health care choices. Visit www.nhdd.org to learn more.
About the Coalition to Transform Advanced Care (C-TAC)
C-TAC is a national non-profit, non-partisan alliance of patient and consumer advocacy groups, health care professionals and providers, private sector stakeholders, faith-based organizations, and health care payers with the shared vision that all Americans with advanced illness, especially the sickest and most vulnerable, will receive comprehensive, high-quality, person-centered care that is consistent with their goals and values and that honors their dignity.
To find out more about C-TAC, its members and action plan, please email [email protected] and follow the Coalition on Twitter, @CTACorg.
