Introduction
Detering, Arnold, & Dizon (2014) describe advance directives as the documents, which an individual completes while still having the decisional capacity regarding the way treatment decisions ought to be made on his/her behalf in the event he/she losses this decisional capacity. Thus, advance directives allow an individual clarify his/her decisions regarding end-of-life care in advance. According to Thomas & Lobo (2011), advanced directives failed in achieving their goals, which are giving the ill people and their family more control over their care and ensuring that their wishes regarding the rejection of treatment were recognized, even though they were not capable of communicating those wishes. The present paper maintains that the advanced practice nurses and nurse educators should not advocate for the public policies, which encourage the use of advance directives thereby promoting a culture of restrained interventions at the end of life.
Restrained interventions involve the utilization of chemicals, a mechanical device, or physical force to reduce the patient’s ability to move their bodies or parts of their bodies. According to Zwijsen et al. (2011), the restraint concept in nursing home care continues being ambiguous. Norwood et al. (2011) describe restraint as a risky and intrusive intervention, which can have substantial adverse effects on the emotional and physical well-being of the people who are restrained. For this reason, the possibility of the restraint use at the end of life need to be reduced as much as possible because of the harmful effects it has on the patients. Kvale et al. (2015) found out that 1 in 6 veterans who passed away in the inpatient setting were essentially restrained during the time of death. Consequently, the advance practice nurses and nurse educators should not advocate for the public policies that facilitate the application of advance directives leading to promotion of a culture of restrained interventions at the end of life.
References
Detering, K. S. M. J., Arnold, R. M., & Dizon, D. S. (2014). Advance care planning and advance directives. UpToDate, Inc.
Kvale, E., Dionne-Odom, J. N., Redden, D. T., Bailey, F. A., Bakitas, M., Goode, P. S., Williams, B. R., Haddock, K. S, & Burgio, K. L. (2015). Predictors of physical restraint use in hospitalized veterans at end of life: An analysis of data from the BEACON Trial. Journal of palliative medicine, 18(6), 520-526.
Norwood, L., Ciccone, J. R., Kennedy, D. M., Faucher Moy, D. L., Allrich, M. K., & Naiditch, Z. (2011). National review of restraint related deaths of children and adults with disabilities: The lethal consequences of restraint. Equip for Equality, 4.
Thomas, K., & Lobo, B. (2011). Advance care planning in end of life care. Oxford University Press.
Zwijsen, S. A., Depla, M. F., Niemeijer, A. R., Francke, A. L., & Hertogh, C. M. (2011). The concept of restraint in nursing home practice: a mixed-method study in nursing homes for people with dementia. International Psychogeriatrics, 23(05), 826-834.
