A practical nurse (PN) is conducting a home visit for a hospice client who has a Physician Orders for Life-Sustaining Treatment (POLST) form specifying 'Do Not Resuscitate' (DNR). The client is currently disoriented and lacks capacity. The client's spouse suddenly states, 'I cannot just let them die. I want you to do CPR if they stop breathing.' In which order should the PN perform the following actions? Arrange the actions from first to last.
- 1Verify in the medical record that the spouse is the legally designated healthcare proxy.
- 2Confirm the spouse's explicit intent to revoke the client's 'Do Not Resuscitate' order.
- 3Remove the physical POLST form from its prominent location in the home.
- 4Contact the hospice healthcare provider to report the revocation and obtain updated orders.
- 5Document the spouse's exact statements and the voiding of the POLST form in the clinical record.
Answer
The correct sequence is to first verify the spouse's legal proxy status, then confirm their explicit intent to revoke the DNR, followed by removing the physical POLST form from the home. After securing the physical environment, the PN contacts the provider, and finally documents the event.
When a proxy requests to revoke a DNR for a client lacking capacity, the first step is to verify their legal authority (Durable Power of Attorney for Healthcare). Once verified, the PN must confirm their explicit intent to ensure it is not merely an expression of grief. After confirming intent, the immediate priority is client safety: the PN must remove the physical POLST form (often kept on a refrigerator) to prevent emergency medical services (EMS) from mistakenly withholding CPR if the client suddenly arrests. After securing the physical environment, the PN notifies the healthcare provider to officially cancel the written medical order. Finally, after the situation is safely managed and communicated, the PN documents the proxy's exact words and the actions taken in the legal health record.
Step-by-Step Solution
Key Concept
A legally designated healthcare proxy can revoke a DNR on behalf of a client who lacks capacity. The nurse must verify proxy status, confirm intent, prioritize immediate safety by removing physical DNR identifiers, and then coordinate with the provider.