title: Physician Orders for Life-Sustaining Treatment for nursing home residents with dementia.
abstract: OBJECTIVE
  Many nursing home (NH) residents with dementia receive burdensome, aggressive treatments at the end of life (EOL). The Physician Orders for Life-Sustaining Treatments (POLSTs) paradigm is a strategy to enhance EOL care. This article describes the history and features of the POLST paradigm, discusses the potential advantages of using this paradigm for NH residents with dementia, and briefly explores challenges that nurse practitioners (NPs) face in using the POLST for persons with dementia.
  
  
  METHODS
  Review of the literature.
  
  
  CONCLUSIONS
  Potential advantages associated with implementation of POLST in NH residents with dementia include increased communication and documentation about residents' EOL care preferences, increased concordance between care preferences documented in POLST forms and EOL care provided to residents, and lower rates of unwanted, burdensome treatments at EOL. POLST may also guide NPs in communicating EOL care options with residents and/or their surrogates. However, difficulty interpreting and explaining POLST care options, lack of understanding of POLST, limited discussions, and issues with surrogate authority and scope of practice are challenges that NPs may face in caring for NH residents with dementia.
  
  
  CONCLUSIONS
  NPs should assess and optimize their knowledge and skills to conduct goals of care discussions, including POLST discussions.
authors.affiliation: University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
authors.forename: Hyejin
authors.initials: H
authors.lastname: Kim
authors.affiliation: University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.|Philadelphia VAMC, Philadelphia, Pennsylvania.
authors.forename: Mary
authors.initials: M
authors.lastname: Ersek
authors.affiliation: University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
authors.forename: Christine
authors.initials: C
authors.lastname: Bradway
authors.affiliation: School of Nursing, Indiana University, Indianapolis, Indiana.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Hickman
mesh_terms: D016223:Advance Directives; D003704:Dementia / Q000451:nursing*; D006801:Humans; D009722:Nurse Practitioners; D024802:Nurse's Role; D009735:Nursing Homes; D016414:Resuscitation Orders
keywords: Physician Orders for Life-Sustaining Treatments; decision making; dementia; nurse practitioners; nursing homes; palliative care; surrogates