Abstract
The paper discusses end-of-life decisions, advance directives and patient advocacy that are issues within the scope of the health care social worker. The paper shows how the complexity of legal and medical issues involved in the creation of a living will and/or providing surrogate instructions is beyond the medical or legal training of the social worker.

From the Paper
"A social worker acts as a patient advocate. Social workers are charged with promoting patient respect and respect in treatment in end-of-life situations. The National Association of Social Workers was one of the first professional organizations to actively participate in support of the ethical dilemmas inherent in caring for individuals during end of life circumstances by issuing the formal policy statement "Client Self-Determination in End-of-Life Decisions in 1993 (Luptak, 2004). In the area of living wills, the social worker should only be part of a team that can help you address end-of-life issues and decisions and the member of the team to assure that other healthcare providers such as doctors and other facility staff know of your decisions ("How social workers," 2004). In the health care social worker's job, no task is more important than advocating for patients' wishes in end of life decisions."

Tags:patient, advocacy, end-of-life, issues, terminal, illness, physicians, lawsuits

Abstract
This paper explains the concept of an advanced directive - where adults make decisions concerning their final days in advance. The purposes of having an advance directive are also explained in the paper. The author justifies the importance of following an advance directive not only because it is a legal and binding agreement, but also because it can spare anguished family members from making difficult decisions. However, many ethical issues ensue when family members disagree with the directives and the paper discusses scenarios where opposition to an advance directive might have merit.

Outline:
Introduction
Purpose of an Advance Directive
Why It Is Important To Follow an Advance Directive
Opposing Positions May Have Merit
Gray Areas in Following An Advance Directive
Arguments for Following an Advance Directive
Research Concerning Whether to Follow or Not
Conclusion
References

From the Paper
"Adults have the right and obligation to make decisions concerning their final days in advance. Whether or not to decline life support if death is imminent, or if a coma state becomes permanent is usually an ethical opinion which has already been formed and the adult who makes a directive concerning their own life under those conditions may make this action permanent by creating a living will or a previously prepared power of attorney, or directive which appoints a health care representative which the doctor may ask the patient to prepare in advance and keeps in the patient's file. It is the view of the writer of this paper that a person's advance directive should be followed, no matter how difficult it may be for the family or medical personnel."

Tags:medical ethics, law, health system

Abstract
In this article, the writer discusses that the role of the social worker as patient advocate is an important one, especially in light of the shift from acute cause of death to chronic illnesses and quality-of-life issues in end-of-life situations. This paper examines the role of living wills and advance directives in light of the services a social worker provides. The opinion stressed is that social workers should not be involved in the education of the chronically ill patients regarding living wills; that it is the responsibility of the physicians, as social workers can not explain the clinical (medical) issues of the advance directive.

From the Paper
"The role of the social worker as patient advocate is an important one, especially in light of the shift from acute cause of death to chronic illnesses and quality-of-life issues in end-of-life situations. This paper examines the role of living wills and advance directives in light of the services a social worker provides. The opinion stressed is that social workers should not be involved in the education of the chronically ill patients regarding living wills; that it is the responsibility of the physicians, as social workers can not explain the clinical (medical) issues of the advance directive."

Tags:medical, living, will

Abstract
This paper looks at the legal and ethical issues of advanced directives and living wills. It gives a sample of a living will, and examples of when advanced directives, patient self-determination, the right to refuse treatment and informed consent are used.

From the Paper
"Under the U S federal law of the Patient Self-Determination Act, patients in most health care institutions are informed of their rights to participate in health care decisions and their right to have an Advanced Directive Center. There are different types of advanced directives and they fall into two main categories: instructive or proxy. Instructive directives allow the patient to state their preferences regarding the provision of specific therapies or classes of therapies such as no blood transfusions, no CPR. Living wills are the most common type..."

Tags:advanced directives, living wills, patients, informed consent

Abstract
The paper explains that advance directives refer to formal documents or verbal statements which determine how a patient's healthcare decisions will be made in case the patient loses the ability to direct the decisions himself. The paper looks at the laws regarding advance directives in a written format, the problems posed by verbal DNR orders and the battery charges that could be faced by nurses or physicians who try to resuscitate a patient in a situation where an explicit DNR order is present. The paper also discusses advance directives' considerable moral importance and benefits as well as their limitations and risks. The paper concludes with the assertion that doctors must discuss the benefits of advance directives with their patients and patients must also become more comfortable with the reality of death and the need for advance care planning.

From the Paper
"Through a living will a patient can himself direct what kind of treatment will be acceptable to him in case he loses his ability to make decisions. Living wills come into operation only when patients lose the ability to communicate to others or when the situations specified in the LW document take place. Such situations specified in the living will may include persistent vegetative state, a terminal illness or inability to take independent decisions. Living wills may also specify what kind of treatments should be allowed or not allowed or may simply specify general goals. The specified treatments may include nutrition, artificial ventilation, artificial hydration and CPR. Through a health care power of attorney, patients can designate a proxy or a person who can take decisions on their behalf when they become incapacitated. This kind of advance directives provides more flexibility than living wills since it is not possible to anticipate all kinds of medical conditions and treatment alternatives that a person may undergo or require in the future. Do-not-resuscitate -- DNR advance directives are a sort of advance directives which explicitly specifies the withholding of techniques like defibrillation, artificially supplied respiratory support, specifically closed-chest cardiac message and CPR. ("Advance Medical Directives.", n. d.); (Feldman; Christensen, 2007)"

Tags:Patient, Bill, of, Rights, DNR, order, treatment, battery

Abstract
This paper looks at some of the controversy surrounding health care directives. The paper explains what a health directive is, looks at the purpose of health directives, explores the problems and controversy associated with them, and suggests a possible solution to these problems. Appended to the paper are notations concerning laws on health care directives, quotes about advanced directives from medical professionals, and a statement on health care directives made by a bioethicist.

From the Paper
"The past few decades have seen an increase in law suits revolving around the final medical wishes of those who fall ill. Media coverage has provided the nation with front row coverage when it comes to people in comas, vegetative states, and no hope of recovery. Family members are often pitted against each other and the hospitals as the patient lays waiting for a decision to be made. One of the things that has been increasing in popularity to prevent such problems is the use of advance directives. While advance directives are gaining in popularity and power their relative infancy creates an atmosphere for problems. Advance directives can lay to rest painful family decisions, as well as doctor decisions that may or may not agree with the family. They provide a blue print of the patient's wishes that everybody can follow."

Tags:supervision, medical, decision, care, legal, documents, vegetative, state, communicate, wishes, incapacitated

Abstract
The paper discusses how nurses are usually the daily care-givers of patients in nursing homes and hospitals. The paper explains that unlike the patient's doctor, the nurse frequently has time for more friendly and personal discourse with the patient or the patient's family, outside of the realm of healthcare, which may permit him or her to establish trust that other healthcare personnel might not be able to share. The paper discusses how in such an event, the nurse might be able to have an impact on what end-of-life decisions the patient or his or her family might make.

From the Paper
"Many Americans find it difficult to discuss death, or even to think about it at times. However, all human beings must eventually face that end. The inability to discuss this inevitable end often creates difficulty for the individual's family members, should he or she become incapacitated without leaving notification of what should be done if extreme measures need to be taken due to severe injury or illness. A great deal of confusion and possible contention can be avoided during such difficult times if the older adult family member has left an advance directive. Advance directives take many forms. Some of the more common of..."

Tags:nursing, directives, malpractice

Abstract
This paper outlines a strategy for teaching the approach of advanced directives conversations to a group of nurses in long-term care. The paper maintains that terminally ill people, elderly and those who are currently living through their end of life are within their rights to have a better, more comprehensive and caring system to help them make and uphold their decisions about end-of-life care.

Outline:
Introduction
Part A Research Base
Presentation Plan
Conclusion

From the Paper
"The older document, titled the living will is important but does not always demonstrate the whole scope of medical care that might be offered an individual if he or she is faced with a specific medical care decision and may need to be amended to include the determination of a proxy for the individual, before such time as one is needed. (Burnell, 1993, p. 219) As such stand alone Advanced Directive documents tend to be more reflective of patient rights (Galambos, 1998, p. 275) as well as very specific medical treatment plans that the patient might opt into or out of given his or her current state of health and his or her personal beliefs and or desires regarding end of life. (Mcnamara, 2001, p. 19) (Shannon & Walter, 2005, p. 651) (Hardwig, 2000, p. 28) Recent legal decisions as well as universal and institutional protocols have stressed individual rights for end of life decision making, yet there are significant issues with cognitive impaired patients, often suffering from deteriorating diseases making decisions, at different stages of disease process. (Kunkel & Wellin, 2006, p. 6) (Lacey, 2006, p. 189)"

Tags:terminal, illness, elderly, treatment, healthcare

Abstract
This paper discusses the different competencies of an advanced practice nurse (APN) and how they are closely related to each other. The paper discusses direct care by the APN, as well as teaching and coaching. It discusses how these competencies have a direct impact on patient care. It also looks at how they impact the development of non-clinical competencies.

From the Paper
"While there are distinct advantages to the DNP program, there are disadvantages to its widespread implementation and possibly surpassing the masters in science in nursing (MSN) as the terminal degree. There is the possibility, as with all programs at the advanced degree level, that curriculum content may be in-depth in some areas while neglected in others. Another disadvantage is that, as an entry-level degree, DNP candidates may not possess adequate prior clinical experience that the APN candidate possesses, as it was also intended to attract individuals with non-nursing backgrounds. As a rigorous program that seeks to help candidates achieve end competencies, the clinically inexperienced DNP candidate may encounter "practical" knowledge gaps that may have to be covered by a longer course length."

Tags:curriculum, coaching, clinical

Abstract
This paper examines the term 'advanced practice nurse' and four distinct roles involved in being such a nurse. The paper points out that all of these roles are based on six core competencies besides the central competency of direct care. The paper includes an interview with a nurse practitioner, focusing on two of those competencies which are derived from Ann Hamric's "Model of Advanced Practice Nursing". The paper concludes that the most important core competency on the basis of this interview is collaboration.

Outline:
Introduction
Advanced Practice Nurse: Four Roles
Interview
Analysis
Conclusion

From the Paper
"The nurse practitioner acts as a primary care or specialty care provider and also as a consultant to individual patients, families, and communities (AANP, 2002). The nurse practitioner is concerned with medical as well as nursing issues, health promotion and maintenance, prevention of disease and acute and chronic disease diagnosis and management (AANP, 2002). Advanced practice nurses work in a variety of settings such as neonatal, pediatric, gerontology, women's health, school and occupational health, adult critical care or family care, and specialize in illnesses such as AIDS (Becker & Kaplow, 2006; AANP, 2002). The advanced practice nurse is not only a skilled nursing clinician but a practice leader who is able to create a significant impact on care across a wide range of settings. Advanced practice nurses work to optimize outcomes for patients, the family, health care providers, and the health organization/system (Becker & Kaplow)."

Tags:nursing, profession, medical, practise, care