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Difficulty: Very hardAdvance Directives and Informed Consent

A practical nurse (PN) at a long-term care facility is preparing to obtain a resident's signature on a consent document for a palliative thoracentesis. The healthcare provider previously discussed the procedure with the resident. The resident has a documented "Do Not Resuscitate" (DNR) order on their chart. When the PN presents the consent document, the resident states, "I know the doctor explained the benefits, but I forgot what they said about the risk of my lung collapsing. Also, I've decided I want to cancel my DNR order starting today." Which of the following actions by the PN are legally and professionally required? (Select all that apply.)

  1. Contact the healthcare provider to clarify the resident's question regarding the risk of a collapsed lung.Answer
  2. Withhold the consent document until the healthcare provider has directly addressed the resident's questions about the procedure.Answer
  3. Inform the healthcare provider and the supervising registered nurse (RN) of the resident's verbal request to revoke the DNR order.Answer
  4. D
    Explain the physiological mechanism of a pneumothorax to ensure the resident understands the risks before signing.
  5. E
    Formally assess the resident's decisional capacity and independently update the code status to "Full Code" in the medical record.
  6. F
    Instruct the resident to sign the consent form to prevent delays, assuring them the provider will answer their questions before the procedure.

Answer

The correct actions are to contact the provider to clarify the risk, withhold the consent document until questions are answered, and inform the provider and RN of the DNR revocation request.
The practical nurse's role in informed consent is limited to witnessing the signature and verifying that the client gave consent voluntarily. Because the resident has questions about the specific risks of the procedure (a collapsed lung), the PN must withhold the consent form and contact the healthcare provider, who retains the sole responsibility for explaining surgical risks. Furthermore, a competent client has the legal right to revoke a DNR order at any time, including verbally. The PN must honor this right by immediately notifying the provider and supervising RN so the medical record and care plan can be legally updated to reflect the new code status.

Step-by-Step Solution

1
Analyze the resident's statement regarding the procedure.
The resident has expressed uncertainty and asked a specific question about a procedural risk (lung collapse).
Identifying that the resident lacks full understanding is critical because it directly impacts the validity of the informed consent process.
2
Determine the PN's scope of practice regarding informed consent.
The PN cannot explain procedural risks or obtain a signature from an uninformed client; the provider must be contacted.
The PN's legal role is strictly limited to witnessing a voluntary signature from a fully informed client, not providing the primary education.
3
Analyze the resident's statement regarding the DNR order.
The resident has verbally requested to revoke their DNR status.
Clients have the right to revoke advance directives at any time, and this change must be acted upon immediately to ensure safe care.
4
Determine the appropriate PN action for the DNR revocation.
The PN must report this verbal revocation to the supervising RN and the healthcare provider.
While the PN cannot independently alter medical orders, they have a professional duty to communicate the client's wishes so the provider can legally update the code status.

Key Concept

The practical nurse's role in informed consent is strictly to act as a witness; the PN must defer risk explanations to the provider. Additionally, the PN must promptly report a client's request to revoke an advance directive to ensure legal documentation is updated.
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Advance Directives and Informed Consent

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