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Difficulty: HardAdvance Directives and Informed Consent

A practical nurse (PN) is providing care for an older adult who has an established "Do Not Resuscitate" (DNR) directive. The individual is being prepared for an urgent surgical intervention. After the surgeon explains the procedure, the client prepares to sign the surgical consent paperwork but states, "I want this surgery, but if my heart stops during the operation, I want you to revive me just this once." Which actions are appropriate for the PN? (Select all that apply.)

  1. Notify the surgeon that the client wishes to discuss temporarily modifying their resuscitation status.Answer
  2. B
    Explain the clinical risks associated with intraoperative chest compressions and intubation to the client.
  3. Delay witnessing the signature on the surgical consent until the surgeon addresses the client's request.Answer
  4. D
    Accept delegation from the registered nurse (RN) to assess the client's cognitive ability to alter the advance directive.
  5. Document the client's exact verbal statements regarding their resuscitation wishes in the medical record.Answer
  6. F
    Proceed with witnessing the consent signature immediately, as a surgical consent automatically nullifies a DNR directive.

Answer

The correct actions are to notify the surgeon of the client's request, delay witnessing the consent signature until the surgeon clarifies the plan, and document the client's exact verbal statements.
The PN acts within their legal scope by advocating for the client (notifying the surgeon), ensuring the consent process is valid (delaying the signature until the client's conditional requests are addressed by the provider), and maintaining accurate legal records (documenting the statements). The PN correctly recognizes that informed consent cannot be fully obtained if the client has unresolved stipulations about their resuscitation status.

Step-by-Step Solution

1
Analyze the client's statement regarding their DNR.
The client is expressing a desire to conditionally revoke or suspend their DNR order specifically for the duration of the surgery.
Identifying the client's intent is crucial to determining the appropriate legal and ethical pathway for modifying advance directives.
2
Determine the PN's scope of practice regarding informed consent in this scenario.
The PN can witness the signature but must not witness it if the client has unresolved expectations about the procedure's terms. The PN also cannot explain the medical risks of the requested resuscitation.
The PN role is limited to verifying voluntary agreement; providing medical explanations or proceeding with a conditional consent breaches this scope.
3
Identify the appropriate communication and documentation requirements.
The PN must notify the surgeon to address the DNR modification, accurately chart the client's statements, and refuse out-of-scope delegations like assessing competency.
Advocacy and documentation are core PN responsibilities, while competency assessment requires RN-level clinical judgment.

Key Concept

Intersection of Advance Directives and Informed Consent within the PN Scope of Practice
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Topics

Advance Directives and Informed Consent

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