Challenges to implementation of advance directives of will in hospital practice

Rev Bras Enferm. 2016 Nov-Dec;69(6):1031-1038. doi: 10.1590/0034-7167-2016-0085.
[Article in Portuguese, English]

Abstract

Objective:: to understand the difficulties and limitations in the implementation of advance directives of will in the hospital context.

Method:: qualitative, exploratory and descriptive study conducted by means of semi-structured interviews with nurses, resident physicians and family caregivers. The data were analyzed by using discursive textual analysis based on the framework of bioethics principles.

Results:: the following categories emerged: Terminality as an expression of loss and cure as an option for care; concerns about legal implications; advance directives of will demand patient autonomy and proper communication.

Conclusion:: limitations and difficulties in practice of advance directives of will from the perspective of the participants show, apart from countless conflicts and dilemmas regarding end-of life matters, that impending death experiences obstruct patients' wishes.

MeSH terms

  • Adult
  • Advance Directives / legislation & jurisprudence
  • Advance Directives / psychology*
  • Attitude to Death*
  • Brazil
  • Family / psychology
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Interviews as Topic
  • Male
  • Medical Staff, Hospital / psychology
  • Middle Aged
  • Nursing Staff, Hospital / psychology