The
Healthcare Legislative Process and Patient Self-Determination

            Nursing is about promoting health and optimal wellness,
alleviating suffering, facilitating healing, and advocating for those receiving
care (American Nursing Association, n.d.). To accomplish this goal, nurses are
required to follow the laws of their country, state, and institution to work
within scope of practice, such as adhering to advanced directives. Health
policy affects nursing scope of practice by helping legally define the focus of
healthcare. If health policy makers have a focus on the treatment of disease
due to a definition of health as the absence of disease, that will decrease
health promotion behaviors such as preventative education (Burkhardt, 2014, p. 393). This paper will
explain the process of healthcare policy creation, the role of the nurse in
this process, and an example of current Ohio legislature regarding patient
self-determination.

Healthcare
Policy

Before an issue is brought to legislature, a predicament
needs recognition. The problem brought to political officials by lobbying, can
include face to face meetings, letter writing, and organizing campaigns to
affect public opinion. Once brought to political officials, the obstacle enters
policy formation and solutions are proposed. The policy is implemented and can be
modified. Healthcare policies can be divided into two different types of
policies. Allocative policies determine allocation of resources. An example of
this is funding for Medicare and Medicaid. Regulatory policies direct actions
such as restrictions on a provider’s quality controls and social regulation,
which direct safe work places (Burkhardt, 2014, p. 394).

Patient Self-Determination

An example of healthcare policy is House Bill
286 by the 132nd General Assembly. This bill creates the Palliative
Care and Quality of Life Interdisciplinary Council, requires certain facilities
to create a method to identify patients who could benefit from palliative care,
and authorize hospice care programs to give palliative treatment to non-hospice
patients (Molnar, n.d.). Palliative care patients benefit from having filled
out advances directives, which according to the Patient Self-Determination Act
of 1990, hospitals, home health care facilities, and long-term care facilities
are required to recognize. This bill was passed in the House and, as of 13
December 2017, is now in the Senate.  House Bill 286 creating a Palliative Care
Council creates an input for advanced directives and allows a voice for patient
autonomy.

There are many benefits of patient
self-determination. By filling out advanced directives, communication is amplified
between patients and healthcare professionals, there is a better clarity about
patient’s wishes, and the assertion that the treatment is aligned with the
patient’s preferences and values is encouraged (Wolf, 1991). This makes sure
there is an ongoing dialogue to maintain a well-defined plan of care. In
addition, the healthcare provider can ensure scope of practice is maintained by
clarifying the patient’s wishes.

Despite the benefits, there are negative
aspects to advances directives. Patients and doctors are uncomfortable with
having a discussion about end of life care, and an estimate of patients in the
United States that have filled out advanced directives are 4 to 24 percent
(Wolf, 1991). In effort to educate patients on advanced directives, facilities
can overwhelm patients with written education materials and may ask about end
of life preferences at inappropriate timing. This decreases patient comfort in
the healthcare setting and disengages the patient from care planning. Another
concern is that untrained personnel would be attempting to help patients with
advanced directives when a physician would be more qualified.

            Based on the above
information, a council to assist in input and assistance for patients under
palliative medicine care would be beneficial. The Patient Self-Determination
Act of 1991 is still in use with minimal modifications after years, meaning it
has maintained relevance. If the physician helps build plan of care with the
patient including advanced directives, the nurse can help reeducate and
maintain the patient’s wishes, which can increase the amount of patient
satisfaction in care.