Friday, July 23, 2004
This presentation is part of : End of Life/Palliative Care
Motivational and Influential Factors for Advance Directive Formulation
Gloria Duke, PhD, RN and Sue Thompson, PhD, RN. College of Nursing and Health Sciences, The University of Texas at Tyler, Tyler, TX, USA
Learning Objective #1: Discuss factors that motivate and influence patients in acute care settings to formulate advance directives
Learning Objective #2: Discern implications for nursing in terms of nursing research and the role of health care providers in facilitating formulation of advance directives

Opportunities for formulating advance directives were expanded with the Patient Self-Determination Act (PSDA) of 1991. Despite the fact that the law mandated that all health care facilities that receive Medicare funds must educate patients and families concerning advanced directives (AD) as well as to provide opportunities for formulating advance directives, very few individuals have taken advantage of this. The purpose of this two-phased, descriptive, correlational study was to identify characteristics and other influential factors of adults admitted to acute care facilities that impacted their decision to formulate an advance directive. Phase 1 of this study comprised a qualitative study to identify influential and motivating factors, and from this data, a quantitative tool (Advance Directive Assessment Tool, ADAT) was developed. Quality of Life (Life Satisfaction Index: A) as a possible motivating factor and the ADAT were used in Phase 2 of this study. The sample comprised 47 patients admitted to one of two acute care facilities. Results revealed social workers and lawyers were more involved with initiating and assisting patients with advance directives. When asked what the biggest factor was concerning the reason for formulating an AD, participants responded that they did not want to be a burden to their family. Significant relationships were detected between selected life satisfaction items and social support, age, and spirituality. Several implications of this study emerged based on the findings. Clearer role definitions of health care providers need to be defined in terms of AD initiation. Future nursing research should be targeted toward further explanatory and predictive studies with larger and more diverse samples. This may facilitate advance directive initiation in order to give individuals as well as their loved ones peace of mind and to prevent individual wishes from not being fulfilled.

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Sigma Theta Tau International
July 22-24, 2004