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Advance directives were created in response to the increasing sophistication and prevalence of medical technology. [3] [4] Numerous studies have documented critical deficits in the medical care of the dying; it has been found to be unnecessarily prolonged, [5] painful, [6] expensive, [7] [8] and emotionally burdensome to both patients and their families.
The Patient Self-Determination Act (PSDA) was passed by the United States Congress in 1990 as an amendment to the Omnibus Budget Reconciliation Act of 1990.Effective on December 1, 1991, this legislation required many hospitals, nursing homes, home health agencies, hospice providers, health maintenance organizations (HMOs), and other health care institutions to provide information about ...
A person will typically have these conversations with their doctor and ultimately record their preferences in an advance healthcare directive. [9] An advance healthcare directive is a legal document that either documents a person's decisions about desired treatment or indicates who a person has entrusted to make their care decisions for them ...
An advance directive allows an individual to state what treatments he or she would want in a medical crisis, but it is not a medical order. [4] Advance directives are not portable in a sense that it is not accessible across medical systems, so it is the individual's responsibility to have the form on them at all times. [ 4 ]
When filing an advance directive, an alternate health care agent should be identified. The surrogate decision maker must be a trusted individual that is able to make crucial decisions on behalf of the advance directive client. The advance directive should also indicate specific instructions for when a patient is incapacitated.
In a 5–4 decision, the Court affirmed the earlier ruling of the Supreme Court of Missouri and ruled in favor of the State of Missouri, finding it was acceptable to require "clear and convincing evidence" of a patient's wishes for removal of life support. A significant outcome of the case was the creation of advance health directives.
Where the patient's advance decision relates to a refusal of potentially life-saving or life prolonging treatment, this must be recorded in writing and witnessed. Any advance refusal is legally binding, providing that the patient is an adult, the patient was competent and properly informed when reaching the prior decision.
A nursing care plan promotes documentation and is used for reimbursement purposes such as Medicare and Medicaid. The therapeutic nursing plan is a tool and a legal document that contains priority problems or needs specific to the patient and the nursing directives linked to the problems. It shows the evolution of the clinical profile of a patient.