Current Content
Volume 46 - Number 1
January/February 2020

Improving Nurses' Understanding of Pediatric-Focused Advance Directives
Kylie B. Ewing

Nurses caring for pediatric patients with life-limiting and life-threatening conditions are often faced with the challenge of providing care to patients receiving palliative and hospice care. In some instances, patients or caregivers (such as a parent or guardian) will have had advance care planning discussions with their palliative care team that are not directly shared with the interprofessional team, including nursing staff providing direct patient care. Despite caring for chronically ill patients, nurses are often unfamiliar with the advance care planning process, and are uncertain of their role in advance care planning, how to incorporate the patient's wishes into daily nursing care, and how to assist with patient and family decision-making surrounding advance directives. Although there is substantial literature available distinguishing the differences between palliative care and hospice care, as well as the need for early palliative care consultation intervention, less information and knowledge exist about what advance directives are available in the pediatric patient population. This uncertainty coupled with a lack of knowledge in how to best navigate these difficult conversations may delay pertinent advance care planning conversations. By understanding pediatric and adolescent and young adult-focused advance directives (specifically, Five Wishes®, Voicing My CHOiCES™, and My Wishes), pediatric nurses will better understand their role in guiding and supporting patients and families, and as a result, be better prepared to assist with the advance care planning process.