Promoting communication and documentation of advance care planning in long-term care facilities.

This paper describes the findings of Phase I of an advance care planning (ACP) demonstration project, undertaken collaboratively between the Texas Partnership on End-of-Life Care and the North Texas Alliance of Nursing Homes. The goal of the project, designed as a continuous quality improvement program for the nine volunteer nursing facilities (NFs), was to increase the systematic implementation of ACP Phase I consisted of baseline data collection of ACP documentation from the nine NFs. This was followed by a pre-intervention train-the-trainer educational program for facility coordinators and other interested staff who subsequently would implement the procedures in their NFs, to increase the use of advance directives (ADs).

Long-term care nurses' knowledge of end-of-life care.

Long-term care (LTC) facilities usually contract with hospice agencies to provide palliative (comfort) care to their terminally ill residents, yet only 1% of nursing home residents enroll in hospice care. Integrating hospice services with nursing home services presents many challenges. One of the most critical challenges is the lack of education in palliative care among physicians, licensed nurses, and certified nursing assistants in LTC settings.

Legal and ethical issues in end-of-life care.

Advances in medical technology during the past 3 decades altered the scenarios of our dying. It is now possible to prolong life, with the frightening reality that we also can extend death. This paper examines challenges to dying well in America, defines key end-of-life dilemmas faced by critical care nurses, and examines legal and ethical issues related to dying persons' care.