Improving Advanced Care Planning through Proper Implementation of the POLST Paradigm: An Integrative Review
School of Nursing
Doctor of Nursing Practice (DNP)
POLST Paradigm, POLST, DDNR
Medicine and Health Sciences | Nursing
Shomo, Charles Hunter II, "Improving Advanced Care Planning through Proper Implementation of the POLST Paradigm: An Integrative Review" (2021). Doctoral Dissertations and Projects. 2930.
End of life planning is critical to ensure enactment of patient wishes, ethical patient treatment, and improved family acceptance of death. As such, this project addressed integration of reviewed literature of advanced planning directives to influence end-of-life care. Implementation guidelines and incorporation of the Physician Orders for Life Sustaining Treatment (POLST) paradigm was the central focus of this project. Addressing best implementation practices of the POLST paradigm should increase advanced care planning and ultimately positively impact patient and surrogate decisions regarding end of life management and care. Completion of this integrative review has provided substantial implicative evidence regarding best practice standards related to the POLST paradigm. The need for robust end-of-life discussions, the universal applicability of the POLST paradigm form, and widespread adaptation suggest the POLST paradigm should be used when advanced care planning. The literature also suggests some troubling findings such as form misinterpretation, misapplication, and overall inconsistencies of use. Also, of note was the universal applicability of the POLST paradigm spanning racial, cultural, and medical diversity. Given the review question and project goals, implementation strategies such as standardized and comprehensive education, consistent form completion, and appropriate advanced care planning conversations can avoid pitfalls experienced with prior POSLT rollouts and mitigate many of the common themes found in the reviewed articles.