IMPLEMENTATION OF AN ADVANCE DIRECTIVE POLICY AT A MILITARY MEDICAL CENTER (PATIENT SELF DETERMINATION ACT).
Contributors: Indiana University School of Nursing.
Published: 1996
Number of pages: 256
Subjects: Health Sciences, Health Care Management.; Health Sciences, Nursing.
Description: The purpose of this case study was to define the policy problem as perceived by health care professionals required to implement the Patient Self Determination Act (PSDA). The research question was "what were health care providers' perceptions about the impact of the PSDA and the resulting institutional policy on patient decision making about end-of-life issues?" Research objectives were (1) determine the degree to which one military hospital met the documentation intent of the PSDA; (2) describe factors that health care personnel perceived as helping or hindering implementation of the policy; and (3) describe potential solutions to hindering factors suggested by health care professionals.

A preliminary study, using retrospective health record reviews, secondary analysis of data and concurrent observation was conducted. Being widowed was the only demographic characteristic significantly related to having an advance directive (p. = 0049). The results of the preliminary work indicated a policy problem did exist in the medical center. Lack of required documentation was found to be a policy-related problem.

Focus group methodology was used to determine health care providers' perceptions about policy implementation. Information about how nurses and physicians determined relevance to a patient before implementing the policy emerged from the analysis of focus group data. Some major themes that emerged included assigning responsibility, distrust, policy impacts on patients and ways to measure success of the policy. Factors that helped participants implement the policy included having their own advance directive, previous personal or didactic exposure to the policy, or if a patient requested an advance directive. Eight factors that hindered implementation included the local legal code, downsizing that resulted in a heavy workload, and patient attributes. Solutions to those hidrances included making information about advance directives more accessible. How the policy was really implemented also emerged from the interview data.

Feasible recommendations for education, service, nursing, policy adaptations and research were made based on participant suggestions. Recommendations included education programs for staff and patients, and studies to determine if the themes found in this study are generalizable to other populations.
Notes: Source: Dissertation Abstracts International, Volume: 57-10, Section: B, page: 6160.

Thesis (D.N.S.)--INDIANA UNIVERSITY SCHOOL OF NURSING, 1996.

School code: 0815.