Implementing advance directives—An international literature review of important considerations for nurses

Teresa Dowling, Sara Kennedy, Sinead Foran

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Aim(s): To review the global literature on the implementation of advance health care directives to date, and the experiences of the health care professionals who must initiate the discussions around advance care planning, as well as support patients' ultimate decisions. Background: Ireland's Assisted Decision-Making (Capacity) Act 2015 legalizes advance health care directives. It promotes the autonomy of the person and enables them to have treatment in accordance with their will and preferences. However, there is professional uncertainty on how to support and integrate assisted decision-making. Evaluation: 16 studies featuring the views of health care professionals are included and evaluated using a framework of ‘benefits versus challenges’. Key issue(s): Four themes clearly emerge during the review process: the concept of capacity and who decides; autonomy versus paternalism—conflict among the health care professional/patient/family caregiver triad; barriers to advance directives; and timing issues. Conclusion(s): Significant benefits of advance health care directives exist for all parties including less stress for patients and families alike, less burden and less residual guilt for surviving relatives, and an over-arching prevention of ‘crisis’ decision-making. Implications for Nursing Management: This review highlights the central role of the nurse in empowering patients to express their wills and preferences, supporting patients' capacity to make decisions about their own care, initiating end-of-life care discussions and advocating to have advance health care directives acknowledged. Moreover, it identifies the challenges ahead for all nurse managers in implementing this new mandate.

Original languageEnglish
Pages (from-to)1177-1190
Number of pages14
JournalJournal of Nursing Management
Issue number6
Publication statusPublished - 01 Sep 2020


  • advance care planning
  • advance directives
  • decision-making
  • living wills
  • paternalism


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