!have been a nurse for 30 years, working mostly in the field of geriatrics. The Patient Self -Determination Act, which gives adults the right to choose and profess their wishes, has certainly been needed. The federal act states that all healthcare facilities receiving Medicare or Medicaid funds must inform patients of their right to participate in treatment decisions. This can be accomplished through public education to increase awareness of living wills and durable powers of attorney for health-care decisions.
I reflect on a patient I took care of years ago. When she was admitted into a long-term care facility, she was alert, oriented, and capable of communicating her needs. Mrs S enjoyed socializing with other residents. She participated in activities such as Bingo, crafts, and exercise programs. Mrs S was pleasant, cordial, and had a unique sense of humor. She would occasionally tell jokes to the staff.
As her disease progressed, her physical ability declined. She became totally dependent due to the latent stage of Parkinson's disease. Mrs S could not walk or feed herself. She choked easily and required total assistance with activities of daily living. She was given a gastrostomy and was bolus fed several times a day. As I looked at this once vivacious lady, I wondered what were her thoughts? She no longer spoke, but on rare occasions would smile.
One day, when I went into her room to feed her, I said, //Mrs S, it's time to eat again." She shook her head no. From that day on, when I would feed her, she would look at me with big, staring eyes and shake her head no.
What was she trying to tell me? Stop? Don't? Let me be? No more? Did her eyes express a mixture of pain and anger? What would Mrs S have said if she had been given the opportunity to participate in treatment decisions?
Mrs S had not expressed her desires, but somehow I feel that Mrs S has contributed to my understanding of the Patient Self-Determination Act. Mrs S helped me realize the importance of patients' rights to participate in their plans of care and treatment decisions.
Self -participation, selfknowledge, and taking care of one's self is a vital part of life.