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Difficulty: HardAdvance Directives and Informed Consent

A practical nurse (PN) is assigned to a resident with end-stage heart failure at an extended care facility. The resident's current medical record indicates a "Full Code" designation. While receiving morning care, the resident states, "I am tired of fighting this disease. I want my paperwork changed to 'Do Not Resuscitate' (DNR)." A visiting family member immediately interrupts, stating, "No, you cannot do that! We want everything possible done to save you." In what order should the PN take the following actions? Arrange from first action to last.

  1. 1Request the family member to temporarily step out of the room to provide a private environment.
  2. 2Affirm to the resident that their legal right to make autonomous healthcare decisions will be respected.
  3. 3Report the resident's verbal request to change their resuscitation status to the charge nurse and attending provider.
  4. 4Document the resident's exact quotes and the presence of family disagreement in the electronic health record.
  5. 5Assist in providing the facility's official advance directive forms for the provider to review with the resident.

Answer

The correct sequence prioritizes client safety and autonomy, followed by escalation, documentation, and administrative preparation: 1) Request the family member to leave, 2) Affirm the resident's rights, 3) Report the request, 4) Document the event, 5) Assist with forms.
The correct sequence follows the nursing process and prioritization frameworks. The PN must first secure a safe, private environment (removing the family member) to assess the client's true wishes without coercion. Next, the PN supports the client's autonomy (advocacy). Once the uncoerced request is confirmed, the PN escalates the critical information to the provider and RN (communication). Documentation follows the clinical actions to ensure an accurate legal record. Finally, the PN assists with the administrative task of gathering forms for the provider, staying strictly within the PN scope of practice.

Step-by-Step Solution

1
Request the family member to temporarily step out of the room.
Establishes a private, non-coercive environment for the resident.
Competent clients have the right to make healthcare decisions free from undue influence. Removing the dissenting family member is the immediate priority.
2
Affirm to the resident that their legal right to make autonomous decisions will be respected.
Validates the resident's wishes and provides psychosocial support.
The PN must advocate for the client's autonomy and reassure them that their advance directive requests supersede family demands.
3
Report the resident's verbal request to the charge nurse and attending provider.
Initiates the formal process of changing the medical code status.
A PN cannot independently write a DNR order. The provider must be notified immediately to discuss the prognosis and execute the legal order.
4
Document the resident's exact quotes and the family disagreement in the health record.
Creates a legally binding, objective account of the interaction.
Prompt and accurate charting protects the client's rights and provides liability protection for the facility during family disputes.
5
Assist in providing the facility's official advance directive forms.
Prepares the environment for the provider's evaluation.
While the PN cannot obtain the informed consent for a DNR, they can facilitate the process by ensuring the correct legal forms are available for the provider.

Key Concept

Client Autonomy and Advance Directives
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Topics

Advance Directives and Informed Consent

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