Hames, Carolyn

Advisor Department

Nursing, College of




advance directive; end of life care; patient wishes


End of life is a topic many people would rather avoid discussing. Even many healthcare providers are uncomfortable with the topic, and they are at the front line in terms of providing information to patients about their care options. Nevertheless, it is a topic of utmost importance. Regardless of what one values and what choices have been made, preferences and desires at the end of life should be honored. This was the aim of documents such as advanced directives, living wills, and durable power of attorneys for healthcare, but they have been found to not be consistently honored. Seeing this disparity, the POLST, Physician Orders for Life Sustaining Treatment, paradigm was created in 1991 to communicate end of life care wishes of individuals who are critically ill or frail. POLST is a portable set of medical orders that specifies what types of medical treatment a patient wishes to receive, or not to receive, toward the end of life. It was created with the goal of improving quality of care, preventing unwanted or medically ineffective treatment, reducing patient and family suffering, and ensuring that patient preferences are honored.

The motivation for my project transpired after an experience I had as a student nurse intern at a hospital in NJ during the summer of 2013. My nurse preceptor was handed a POLST document by our patient’s daughter who stated “these are my mother’s wishes.” My preceptor took the document and proceeded to ask every nurse on the unit if they knew what it was, and no one did. As the intern, I did research and discovered that a law had been passed three months prior making it mandatory to honor this signed medical order for end of life treatment. I was alarmed to think that my patient’s wishes were at risk of being dishonored because we as health care providers lacked knowledge regarding the existence of this new document.

After further investigation I discovered that Rhode Island would join the POLST paradigm by endorsing the MOLST, Medical Orders for Life Sustaining Treatment, on January 1, 2014. I took this as the perfect opportunity to be proactive and devote my senior year to educating nurses throughout Rhode Island on the MOLST. My goal is to ensure that these nurses gain the knowledge needed to honor the MOLST with comprehension and awareness. As a nursing student and thanatology minor, I wholeheartedly believe in the right of an individual to have control of their care at the end of life, and value the MOLST as an effective new way to ensure individual choices are honored.

I carried out my project by providing in-service education sessions to nursing and rehabilitation facilities throughout the state. I coordinated with Directors of Nursing as well as Director’s of Staff Development to ensure attendance of registered nurses at these sessions. This project gave me the valuable opportunity to spread knowledge that will enhance end of life care, gain insight into the level of comfort nurses have in discussing end of life care, and listen to personal anecdotes describing situations that could have benefited had a MOLST document been enacted earlier. I received positive feedback and much appreciation for the education I provided, as well as for the permission I granted them to utilize my power point in the future to educate newly hired nurses, patients, and patient families.