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Difficulty: HardAdvance Directives and Informed Consent

An alert and oriented client receiving treatment for a systemic infection decides to leave the facility Against Medical Advice (AMA). The registered nurse (RN) is managing a crisis on the unit and directs the practical nurse (PN) to obtain the client's signature on the AMA form. Upon entering the room, the client states, 'I just want to go home. The doctor hasn't been here today, and no one has explained what will happen if I leave now.' Which action is the priority for the practical nurse?

  1. A
    Educate the client about the potential complications of an untreated systemic infection before obtaining the signature.
  2. B
    Inform the client that a practical nurse is not legally permitted to witness an AMA document and they must wait for the RN.
  3. Hold the AMA paperwork and contact the healthcare provider to counsel the client regarding the specific risks of leaving.Answer
  4. D
    Witness the client's signature as directed by the RN and document the client's verbal statements in the medical record.

Answer

The practical nurse must hold the AMA paperwork and contact the healthcare provider to counsel the client regarding the specific risks of leaving.
Informed refusal, such as signing an Against Medical Advice (AMA) form, requires the same principles as informed consent. The healthcare provider is legally responsible for explaining the specific medical risks and consequences of refusing treatment. Because the client explicitly stated they do not understand the consequences of leaving, the practical nurse must withhold the document and notify the provider to counsel the client. The practical nurse's role is strictly limited to witnessing the signature after the provider has ensured the client is fully informed.

Step-by-Step Solution

1
Evaluate the client's understanding of the AMA document.
The client explicitly states that no one has explained the medical consequences of leaving the facility.
A valid signature requires the client to be fully informed about the specific risks of refusing medical treatment.
2
Determine the appropriate scope of practice for the practical nurse regarding informed refusal.
The practical nurse recognizes that explaining the medical risks of leaving is the responsibility of the healthcare provider, not the nurse.
The practical nurse's role is strictly limited to witnessing a voluntary signature, but only after the provider has fulfilled the duty of disclosure.
3
Select the priority intervention.
The practical nurse declines to witness the form at this time and contacts the healthcare provider to speak with the client.
This ensures client safety and legal compliance with the principles of informed refusal before the AMA form is executed.

Key Concept

Advance Directives and Informed Consent
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Topics

Advance Directives and Informed Consent

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