title: When, how, and why of advance directives: tools for the cardiovascular nurse.
abstract: In the U.S., cardiovascular disease is the number one cause of death. The chronicity and unpredictable nature of cardiovascular disease will affect thousands of patients and families who are often called upon to make difficult end of life choices. The federal legislation of the Patient Self Determination Act (PSDA) was passed in 1990 and went into affect in December of 1991. The essence of this legislation was to empower the public with the right to make end of life decisions. However, after almost 10 years of implementation there is little evidence of national acceptance by the health care industry as evident in the literature. Likewise, the public demonstrates limited knowledge regarding advance directives. The law applies to all health care facilities that receive any federal reimbursement for services and includes hospitals, nursing homes, home health agencies, and clinics. The PSDA requires health care institutions to establish mechanisms for disseminating information about advance directive, to patients and to designate personnel responsible for discussing advance directives with patients. In this paper, practical and clinical application to the special considerations of the patient and end of life choices will be discussed. A focus on facts, resources, and other information will be presented for the cardiovascular nurse in a variety of health care settings.
authors.affiliation: Surgical Heart Services, Columbus, OH 43214, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Crego
mesh_terms: D016223:Advance Directives / Q000331:legislation & jurisprudence; D000368:Aged; D002318:Cardiovascular Diseases / Q000451:nursing*; D004181:Directories as Topic; D005260:Female; D006801:Humans; D008297:Male; D009723:Nurse-Patient Relations; D019726:Patient Self-Determination Act; D011368:Professional-Family Relations; D014481:United States