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Difficulty: HardAdvance Directives and Informed Consent

A client with a documented Do Not Resuscitate (DNR) order is in the preoperative holding area awaiting palliative surgery. The surgeon has completed the informed consent discussion and exited the area. As the practical nurse (PN) prepares to witness the signature on the surgical consent form, the client asks, "Will my DNR order be suspended while I am under anesthesia?" Which action is the priority for the PN?

  1. A
    Inform the client that facility protocols mandate the temporary suspension of advance directives while in the operating room
  2. B
    Instruct the client to write their specific resuscitation preferences in the margin of the consent document prior to providing their signature
  3. Suspend the signing process and notify the surgical and anesthesia team that the client requires clarification regarding their resuscitation statusAnswer
  4. D
    Reassure the client that the DNR order remains strictly active and legally binding throughout the entire surgical procedure

Answer

The correct action is to suspend the signing process and notify the surgical and anesthesia team so they can clarify the client's resuscitation status.
The role of the practical nurse (PN) during the informed consent process is limited to witnessing the client's signature and ensuring the consent is voluntary. When a client asks a question about the procedure, its risks, or how it affects their advance directives (such as a DNR order during anesthesia), the client is not fully informed. The standard of care for perioperative DNR orders involves a 'required reconsideration' discussion between the provider and the client. Therefore, the priority action is to stop the signing process and notify the providers (surgeon and anesthesiologist) so they can address the client's concerns before the document is signed.

Step-by-Step Solution

1
Identify the client's question as a need for further medical clarification regarding the impact of the procedure on their advance directive.
Recognizes that the client does not have fully informed consent at this moment.
Informed consent requires the client to fully understand the procedure and its implications, including how anesthesia affects a DNR order.
2
Determine the scope of practice for the PN in this scenario.
Concludes that explaining perioperative DNR policies is the responsibility of the provider.
The PN's role in informed consent is limited to witnessing the signature and verifying voluntary agreement, not explaining procedural risks or overriding medical directives.
3
Halt the consent process and escalate the client's question.
The surgeon and anesthesiologist are notified to return and discuss the perioperative DNR status with the client.
This ensures the client's legal rights are protected and that consent is obtained only after all questions are answered by the appropriate provider.

Key Concept

Practical Nurse Role in Informed Consent and Advance Directives
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Topics

Advance Directives and Informed Consent

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