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Welcome to the End of …

Welcome to the End of …. Objectives:. Define Advanced Directives Relate cultural competency to patient self-determination and nursing care Identify the implications of these concepts to the CNL role. Cultural Competency & Advanced Directives. Advanced Healthcare Directives. Instructions on:

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Welcome to the End of …

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  1. Welcome to the End of …

  2. Objectives: Define Advanced Directives Relate cultural competency to patient self-determination and nursing care Identify the implications of these concepts to the CNL role

  3. Cultural Competency & Advanced Directives

  4. Advanced Healthcare Directives • Instructions on: • Type of care • Decision-maker: proxy/surrogate/agent • When an individual becomes unable to communicate for himself.

  5. Advanced Healthcare Directives • Types: • Durable Power of Attorney for Health Care • Living Will • Do Not Resuscitate (DNR) order

  6. TRIAD 1: The Realistic Interpretation of Advanced Directives (Mirarchy, Hite, Cooney, Kisiel & Henry, 2006) • N=452, 62% Nurses, 64% Female, • Ave. years as nurse=13.3 • Findings: • Living Wills (LW)/ADs are misunderstood as DNR orders • DNR is misunderstood as Comfort or EOL care

  7. TRIAD 1: The Realistic Interpretation of Advanced Directives • Implications: • Effect on some MDs: Less aggressive critical care procedures, fewer interventions, less documentation. • Effect on some nurses: decreased aggressiveness in nursing care with elderly who are DNR; delays in notifying MD of change in clinical status in DNR pts.

  8. Multicultural & Multi-Ethnic Considerations & Advanced Directives: Developing Cultural Competency (Giger, Davidhizar & Fordham, 2006) • ADs are based on four interrelated values promoted by the Patient Self-Determination Act (PSDA): • Patient autonomy • Informed decision-making • Truth-telling • Control over the dying process

  9. Four cultural forces that influence End-of Life (EOL) Care: • Biomedical knowledge • Power of technological imperative to determine events • Incompatibility of lay & medical knowledge • General ambivalence about EOL goals

  10. Three traditional values practiced in U.S. healthcare system: • Life is sacred-preserve at all costs. • Maintain autonomous decision-making at all times. • No person should suffer needlessly.

  11. Cultural Patterns

  12. Nursing Implications • Revalidate knowledge according to individual pt’s beliefs • Education & training: Giger-DavidhizarTranscultural Model for Pt Assessment • Value Self-Assessment

  13. CNL Tasks • Train & educate care teams on cultural competence and ADs • Check & ensure LWs/ADs are not misinterpreted by the care team • For referral, create list of care providers who may be more comfortable with Pt’s beliefs or values • Create protocols for caring for Pt’s family

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