Reflection On Provider Order Forms

As registered nurse I have reviewed with my patient on Provider Orders For Life-Sustaining Treatment (POLST). My patient and his wife were not educated in the medical jargon and English is not their first language. At the time I introduced the provider order form, was during a time that my patient had his first stroke. My patient’s wife initially did not know what to do and looked to me for guidance, especially regarding his code status. We talked and I had asked the question on whether they had discussed what to do in the event that they are placed in this situation. I asked what would her husband wishes would be and what he would want done in this situation? She still was unsure and then elected to maintain his code status to be Full Code. I found
that this was not a good time to talk about code status or the provider order form.
Later during their hospital, as her husband nearing discharge plans on going to Rehab of the Pacific, I felt it was a good time to introduced the provider order form. I talked them through the form and explaining the options in each category. Since my patient was unable to sign due to his affected hemi-paralysis and that they did not have an Advance Directive and his wife was not legally designated as his Power of Attorney for Healthcare, his wife would be the patient-designated surrogate. They eventually did not elect to fill out the provider form during that admission. She felt that he was getting better and going to rehab and filling out the form was unnecessary.
However, in explaining the provider order form, I was able give my patient and his wife a peace of mind based on his current medical condition and wishes. Even if my patient and his wife decide not to fill out the provider order form I felt that I have informed them of the information and options should they decide to fill out the form at a later time.
I found out at a later time that that my patient had another stroke, which had more devastating that the first, in which he left him was unable to speak and totally dependent on others for his care. His wife had expressed to me that she wished that they had at least filled out the form that first time in that he was still able to express his wishes. His wife spoke of how he felt very helpless after his rehab that he did not progress as well, leaving still unable to walk, and wheelchair bound and dependent on others for his care. This admission she elected to place a long-term artificial nutrition tube. His wife had contemplated on taking him home or to send him to a long-term care facility after he was medically stable. She did eventually temporarily send him to a long-term care facility then later take him home to care for by herself and family. This time she did elect to fill out the provider order form. I did find out that he passed at home peacefully with family at his side just shy of this 90th birthday.
I found that at by introducing the provider order form is a good introduction for many of my patient and their family members.
I also find that initial introduction of the provider order form should be appropriate. When introducing the provider order form, I stress the importance to either the patient or even the family members of the options based on the person’s current medical condition and wishes. Especially with caring for many elderly patients with multiple medical issues and/or co-morbidities. Just to educate them on not only provider order forms but also the Advance Health Care Directives. In my experience many of my patients and family members are open to the discussion and going over the provider order form. Some think that the form is in regards to property or living will. Many patients and family members like the idea of options they have in the home settings and being able to express their wishes while they still possess decisional capacity. Once they decide to fill the provider order form, I also inform to the patients that they should also informed their family members of the form and their wishes if their family member is not present, so they can support and respect their decisions and
wishes.