Advance Care Planning in Orthopedics

Given that about two-thirds of adults in the United States have not completed any advance directive, and there are over five million inpatient and outpatient orthopedic surgeries each year, there are unparalleled opportunities to engage with patients in advance care planning (ACP) discussions. ACP is defined as an ongoing strategy to help adults across the lifespan identify and communicate their preferences for medical care, based on their individual values and life goals. To meet the call for more widespread ACP documentation, the first levels of the Patton, Zalon, and Ludwick Policy Assessment Framework© can be applied by orthopedic nurses to promote ACP for individual patients and advocate for associated policy changes. The three dimensions and their respective levels: engagement (literacy), partnership (single group, discipline, or organization), and reach (local/unit/organization) are described. Similarly, strategies are explored that the National Orthopaedic Nurses Association could use to set a well-defined ACP policy role for orthopedic nursing.