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Physician Orders for Life-Sustaining Treatment for nursing home residents with dementia

Authors

  • Hyejin Kim MSN, CRNP,

    (Doctoral Candidate), Corresponding author
    1. University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
    • Correspondence Hyejin Kim, MSN, CRNP, University of Pennsylvania School of Nursing, Claire M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104. Tel: 213-746-8490; Fax: 215-573-7507; E-mail: hyejin@nursing.upenn.edu

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  • Mary Ersek PhD, RN, FAAN,

    (Professor of Palliative Care; Director of the Veterans Health Administration PROMISE)
    1. University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
    2. Philadelphia VAMC, Philadelphia, Pennsylvania
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  • Christine Bradway PhD, CRNP, FAAN,

    (Associate Professor)
    1. University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
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  • Susan E. Hickman PhD

    (Associate Professor; Co-director, Research in Palliative and End-of-Life Communication and Training (RESPECT) Center)
    1. School of Nursing, Indiana University, Indianapolis, Indiana
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Abstract

Purpose

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.

Data sources

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.

Implications for practice

NPs should assess and optimize their knowledge and skills to conduct goals of care discussions, including POLST discussions.

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