Advance directives

Advance directives encompasses the process by which a patient learn the various forms of decisions that are important to make and consider before receiving treatment, and to informs both the healthcare providers and family about one’s preferences. Individual desires are regularly put into an advance directive, a legitimate document applicable once a person becomes unable to communicate or incapacitated. This can result from severe disease or injury regardless of one’s age. Thus the advance directives inform one choice of the type of medical care. According to the interviewed individuals, the main obstacles that limited their selective care options included time constraints and lack of health insurance as the most mentioned reasons for avoiding medical care at their age(Sutter et al.,2020). Most importantly, the advance directives enable the healthcare providers to determine the type of medical care that the patient wants and the patient desires and values linked to the end of life care. Therefore, an advance directive acts as a living document that one can modify as one circumstances changes due to new information or a change in critical care. This document helps family members and medical personnel make vital medical decisions in the course of a crisis. The document ensures a person’s wishes concerning health care are executed, even when one is unable to make one’s wishes acknowledged. Both the interviewee saw the advance directive as a constant process where patients, medical providers, and families reflect on the patient’s values, goals, and principles, deliberating on how they should appraise the future and current medical care, and eventually use this evidence to determine the form of medical care to be provided.

The interviewees assert various controversies that arise with the advance directive document. For instance, advance directives create more misunderstanding than precision about a patient’s wishes on whether the document expresses a patient’s true desires and if healthcare staff must constantly follow them. This indicates the existing knowledge gap on the advance directives. Thus recommended an educational program for all nurses to address the knowledge gaps linked to advance health care directives. This will significantly assist in ensuring patients’ desires for care at the end of life treatment are recognized and respected. According to research, even though most adults want their desires for end-of-life care followed, only approximately a third have completed the advance directives legal document and also regardless of the increasing need for advance care planning, most of the health care professionals lack the necessary knowledge on how to, patients concerning the advance directives (Robertsen et al.2020). These highlight the need for nurses to be provided with pertinent and concrete information about advance directives and end-of-life care. Most of the nurses lack the necessary education to efficiently educate patients on making the desired decisions about their wants s at the end of life care. Some of the critical issues related to advance directives include addressing patients’ pain during end-of-life care, matters surrounding healthcare team relations, and the ideal timing of discussions with both the patients and their families concerning implementation of an advance directive.

The interviewees also indicated various barriers that hinder them from discussing the advance directive with the care providers, such as time constraints, language and other inhibitions to communication, and possibly an apprehension by the physician that patients would be distressed by these debates. Equally, the increasing importance on clinical productivity and patient satisfaction makes physicians not start time-consuming advance care discussions; particularly making these discussions may distress their patients. In conclusion, the advance directive discussion are significant nursing responsibility as they help families make better decisions that respect patients’ responsibilities.


Sutter, R., Meyer-Zehnder, B., Baumann, S. M., Marsch, S., & Pargger, H. (2020). Advance directives in the neurocritically ill: a systematic review. Critical care medicine48(8), 1188-1195.

Robertsen, A., Jöbges, S., & Sadovnikoff, N. (2020). Consent, advance directives, and decision by proxies. In Compelling ethical challenges in critical care and emergency medicine (pp. 35-47). Springer, Cham.

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