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ABSTRACT
Living wills and advance directives are important components of patients' medical records, which all too often do not indicate the appropriate palliative care measures the patient desires. A review of the current literature indicates that approximately 85% to 95% of the population does not have adequate advance directives or palliative care measures written in their medical record. Furthermore, these orders may not follow the patient when he or she is transferred to other facilities for intermittent care. Unwanted tracheal intubations can be both costly to the facility and distressing to the patient and family members. By instituting a change in policy, organizations can ensure that patients' wishes for end-of-life care are met appropriately. In addition, nurses should advocate for a centralized database at the political level.
An end-of-life care issue in need of attention is the issue surrounding living wills, palliative care wishes, and their accessibility for the various health care professionals providing care for the individual. A living will is a written document that specifies the kinds of medical treatment a patient desires and can be very specific or very general. It is a part of a person's advance directive, which also may include documentation regarding a health care proxy and power of attorney. A living will is effective only when it exists and reaches the hands of the health care team caring for the patient. When patients are transferred from one health care institution to another in the course of their illness, the living will document may not always follow them, thereby leaving patients' true wishes regarding end-of-life decisions in the hands of well-meaning family members or medical professionals. The family member who has the copy may not always be present when the patient is being admitted to a different facility or hospital.
According to Domrose (2004), referring to the palliative care clinical guidelines published by the National Consensus Project for Quality Palliative Care, "patients' top priorities include being free of pain and psychological stress, having control over decisions about their care, avoiding treatments that prolong their deaths, and not burdening their families" (¶13). Many states have implemented a method for ensuring that dying patients' living wills are documents that will travel with the patients, regardless of where they are being...