An oriented and competent client with progressive amyotrophic lateral sclerosis (ALS) is receiving palliative care and continuous non-invasive positive pressure ventilation. The client tells the nurse, "I am exhausted from fighting this. I want to take off this mask and let nature take its course." The client's adult children are at the bedside, visibly distraught, and state, "He is just having a bad day and is depressed. You cannot take it off, he will not survive the night!" There are no advance directives on file. Which action should the nurse take first?
- Request the family members to step out of the room temporarily to privately explore the client's feelings and verify voluntariness.Answer
- BOrganize an immediate interdisciplinary care conference with the provider and family to establish a consensus on the plan of care.
- CInform the family members that the client is competent and possesses the absolute legal right to refuse life-sustaining interventions.
- DRequest a psychiatric consultation to formally evaluate the client's decision-making capacity and screen for clinical depression.
Answer
The nurse should ask the family to step out of the room temporarily to privately explore the client's request.
The priority action is to assess the client's request privately. A competent adult has the right to refuse life-sustaining treatment, but the nurse must ensure this decision is made voluntarily and is not being influenced by the family's presence or distress. Assessing the client alone allows for open, therapeutic communication about their exhaustion and end-of-life wishes.
Step-by-Step Solution
Key Concept
Client Autonomy and Private Assessment in End of Life Care