The Role of Faith Communities and

Congregational Nurses in Advance Directives

 

 Faith communities and congregational nurses uphold people of faith by guiding informed discussions about advance directives. Advance directives are legal documents that allow Ohio citizens to take control of important choices about what they (may or may not) want done in critical health care situations.  In advance directives people choose who they would like to speak for them if they cannot speak for themselves.  These discussions should take place throughout the life span.  For people of faith, advance directives are an expression of stewardship of the life given to them by their creator. Advance directives are rooted in faithful reflections on the meaning of life and one’s relationship with God.

 

With all of the advances in medical care during the last 50 years, it is possible to keep the body functioning with the assistance of modern technology for long periods of time.  The faith community, including the congregational nurse, is in a position to help people think about these difficult decisions and talk to their loved ones about them. The place and time to make difficult decisions about life and death is often within a faith community and with loved ones before situations arise where quick decisions must be made. The faith community with the guidance of the congregational nurse can help people complete the correct paperwork to inform health care providers about their wishes.  In addition, this interchange allows the faith community to stress its understanding of death.

 

Making decisions to direct end-of-life care can be stressful and anxiety producing. Many people have a limited understanding of the medical, spiritual and emotional aspects of the death and the dying process. It is important for the Congregational Nurse to be comfortable and secure in her/his own knowledge and understanding of the process and the varied and interrelated issues involved. All the world religions recognize that death is a part of life. The goal of these conversations is that the decisions made and formally stated within the advance directive documents will reflect the person’s spiritual beliefs. The care provided by the congregational nurse will assist them in finding meaning in dying and hope that extends beyond the grave.

 

The following are important steps that Congregational Nurses should undertake before the Advance Directive documents are completed:

  •  Be aware of your own comfort level with end of life issues.
  • Develop a level of confidence in discussing with others the medical and spiritual concerns which arise at the end of one’s life
  • Affirm your relationship with the person.
  • Encourage the person to describe what gives meaning to their life.
  • Ask the person to describe their personal experiences with dying. 
  • Let the person know that you care and will assist them in developing a plan when they are ready.
  • Inform the person that these discussions are part of good health care. 
  • Explain to the person that making their wishes known guides their health care.  This will provide comfort to them and their  family in time of health crises and results in better end of life care.
  • Begin the advance care planning process slowly.  Remind the person that these discussions need to occur over time and may always be modified.
  • Provide realistic information on the outcomes of resuscitation. Explain that CPR has a broad meaning.  It includes any or all of the following: administration of chest compressions, insertion of an artificial airway, administration of resuscitation drugs, defibrillation or cardioversion, provision of respiratory assistance, initiation of a resuscitative intravenous line and initiation of cardiac monitoring.  Approximately 15% of hospitalized patients survive and return to previous function following resuscitation.  One needs to weigh the risks and benefits of CPR.
  • Educate about nutritional support at the end of life.  Lack of appetite and inability to eat and drink can be a normal part of disease progression and the dying process, which may assist in allowing one to die both peacefully and comfortably.  Force-feeding, the use of IV fluids and tube feedings may be more detrimental than beneficial.  Consequences may include choking, aspiration, nausea, vomiting, constipation, congestion, shortness of breath, edema and excess secretions. 
  • Offer the option of time-limited trials of life-sustaining treatment.
  • Provide information on the meaning of palliative care, hospice care, comfort care and other options that are available.
  • Encourage a discussion with and the inclusion of the rest of the family and other loved ones.
  • Make referrals as needed.
  • Schedule follow-up visits to continue the planning process and complete the documents.
  • During the entire process listen for any discussion that relates to religious practices at the time of death.

 

Healthy adult *

  • Advance care planning is a loving act.  Since you will be making decisions about the kind of care you want, your family will be able to support your decisions.
  • Identify the person that you would want to make decisions for you if you were unable to make the decisions yourself.  It is important to choose someone that will be willing and able to carry out your wishes.
  • Describe your personal goals of treatment that you would want for yourself  if you permanently lost the ability to know who you are, where your are and who you are with.
  • Describe your personal, religious and cultural views that would affect your treatment choices.

 

Adults with an incurable, progressive illness*

  • Consider the same issues as a healthy adult
  • Think about the goals and benefits of treatment for your illness.  Next think about the side effects of the treatment and what would happen if you decided not to receive treatment.
  • What would you need to be comfortable?

 

Adults who may die in the next 6 months*

  • Consider the same issues as a healthy adult as well as an adult with an incurable, progressive illness.
  • What present or future experiences are most important for you to live well at this time in your life?  In what way do you feel that you could make this time especially meaningful to you?
  • What fears or worries do you have about you illness or medical care?  Do you feel that there are needs or services that you need to discuss?
  • Who or what sustains you when you face serious challenges in life?  Do you have any religious or spiritual beliefs that help you deal with difficult times?
  • What life sustaining treatments do you want?  You can state that you would want a time limited trial of specific treatments. 
  • Do you want to be hospitalized?  Will you want hospice services for you and your family?

 

       *Adapted from Respecting Choices: Facilitator’s Manual 2nd Edition,

         Gunderson Lutheran Medical Foundation, La Cross, WI, 2004.

 

Copies of advance directives should be given to the Durable Power of Attorney for Health Care, loved ones, and the attending physicians.  Copies of these documents should also be taken to the health care facility when admitted.  It is also wise to consider whether people should have a copy on file in the faith community, particularly if hospital visitation is one of the pastoral programs.  

Many excellent resources are available to the faith community to help guide the important conversations about advance directives. Congregational nurses and pastoral care staff are strongly encouraged to become fully knowledgeable about advance directives, as well as, their faith communities’ beliefs and practices so they can support and facilitate decision-making.

 

Resources are listed below:

 

Ohio Hospice and Palliative Care Association

1646 West Lane Avenue Suite 2

 Upper Arlington, Ohio 43221-3343

(614) 485-0021 or (800) 776 9513 fax (614) 485-0560

e-mail info@ohpco.org

http://www.hospiceoh.org/living_will.htm

Obtain; Advance Directive Packet, 4th Edition

Obtain:  Conversations That Light the Way: Advance Care Planning.

A Document to Guide Conversations and Make your Wishes Known.

 

 

Five Wishes Document

Five Wishes is a legal document in 35 states that allows adults to plan how they want to be cared for in case they are seriously ill.  The form allows the person completing the form to talk about their personal, emotional and spiritual needs as well as their medical wishes. Five Wishes also encourages discussing your wishes with your family and physician.

1 888 5 WISHES

http://www.agingwithdignity.org/5wishes.html

 

Advance Care Planning Coalition of Greater Toledo

What is Advance Care Planning?  Advance Care Planning is TALKING to your family about your Choices for medical care so they and your health care providers can RESPECT your wishes in the event you are unable to speak for yourself.

Advance Care Planning Hotline 419 725 0523

P. O. Box 541, Maumee OH 43537-0541

Get Forms, Fill out a Health Care Power of Attorney, Determine if you need a document, Have someone speak to your congregation about Advance Care Planning, free of charge.

 

Findlay Area End of Life Coalition
Speaker’s Bureau

Available to give talks to faith communities

Contact: Karen Eubanks

keubanks@bvha.org

419 423 5595

 

Organ Donation

Life Connection of Ohio

800 262 5443 Toledo, 200 535 9206 Dayton

www.lifeconnectionofohio.org

Donor Referral Hotline 877 223 1606

 

Standards and Practice Committee of the

Congregational Nurse Project of Northwest Ohio

Endorsed by the CNPBoard April 27, 2005

 

 

 

 

 

 

 

 

 

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