Management of Care / 07

Make sure to:

  • Assess and evaluate team members’ knowledge of advance directives.
  • Know the components of end-of-life decisions and advance directives.
  • Integrate advance directives into clients’ plans of care.

Nurses typically concentrate on health promotion and restoring their clients to optimal health. However, clients accessing healthcare settings often present themselves with more complex conditions. Although scientific breakthroughs and advanced technology have increased treatment options, some clients prioritize a quality life over the prolongation of life with low quality. Consequently, nurses must be prepared for potential refusal of treatment/procedures by clients and/or their families.

In this learning experience, learners will acquire knowledge on how to assess and evaluate the knowledge of healthcare team members regarding advanced directives and end-of-life decisions, and how to incorporate them into the care plans of all clients.

9.1 Team Members’ Knowledge of Advance Directives

The nurse in charge should assess team members’ knowledge about advanced directives and plan education activities accordingly. Topics include living wills, health care proxy, and Durable Power of Attorney for Health Care (DPAHC). It is crucial for team members to understand that clients who are not incapacitated can make changes to their advanced directives, and nurses need to document in the client’s record whether they completed advanced directives (Burke, 2023). The nurse in charge can assess their knowledge by auditing medical records for documentation related to advanced directives. All education activities should be documented, and additional educational activities should be implemented if evaluations demonstrate knowledge deficit(s).

9.2 Components of End-of-life Decisions and Advance Directives

According to the Uniform Determination of Death Act, death is determined when circulatory and respiratory functions have ceased and cannot be reversed, or when brain functions, including those of the brain stem ceases and cannot be reversed (Burke, 2023).

When clients are incapacitated, they are unable to refuse care or treatment, nor can they provide informed consent. In 1990, Congress passed The Patient Self-Determination Act, allowing Americans to make these decisions before incapacitation occurs. The Act mandates public education, and requires hospitals, psychiatric facilities, and health insurance plans to adhere to advanced directives (Burke, 2023).

Advanced directives include a living will, health care proxy, and Durable Power of Attorney for Health Care (DPAHC) (Burke, 2023). They can be completed by the client, the client and their family member(s), or an attorney.

The components of end-of-life choices and advance directives are as follows:

  • Living will: Also known as an advanced directive, this is a detailed document outlining the clients’ preferences when they are unable to provide permission to receive or refuse care/treatment. It covers decisions such as whether they want or not want tube feedings, cardiopulmonary resuscitation (CPR), invasive procedures, and surgeries (Burke, 2023; Kaplan Nursing, 2023), as well as choices regarding dialysis, respirator, and antibiotics (Kaplan Nursing, 2023). However, they may express a desire to receive pain relief and comfort measures during the end of life.
  • Health care proxy: Also known as a surrogate and durable power of attorney for healthcare, this grants the named person the legal right to make decisions about the client’s healthcare that were not outline in their advanced directive (Burke, 2023; Kaplan Nursing, 2023).  

It is important to note that one can donate some or all bodily organs. According to the US Uniform Anatomical Gift Act, human organs should not be sold or trafficked. An individual can donate one or more of their body parts, and a relative or spouse can donate body parts of a deceased family member or spouse if that person did not elect to donate their organs (Burke, 2023).

9.3 Integration of Advance Directives into Clients’ Plan Care

Nurses have a responsibility to integrate advanced directives into the care plans of all their clients. According to Burke (2023), this can be achieved by ensuring that their clients receive all the documents listed below.

Topics: 

  1. Living wills 
  2. The Uniform Determination of Death Act 
  3. The Uniform Anatomical Gift Act 
  4. Health care proxies and surrogates 
  5. The Patient Self Determination Act 
  6. Durable Powers of Attorney for Health Care (DPAHC)  

Nurses should address questions and ensure that both clients and family members understand each document.

Additionally, the nurse needs to communicate the client’s wishes to other healthcare team members and document their electronic health record that was completed by the client. They should also answer clients’ questions and allow them to make changes if they are still competent (Burke, 2023). Therefore, it is important to review advanced directives when assuming the care of each client since changes could have been made.

Burke (2023) recommends that nurses also consider and address the Five Wishes which are:

  • Type of end-of-life care.
  • Decisions about pain relief and comfort.
  • Who they would like to be their healthcare proxy.
  • The healthcare, including treatment, that they will accept and refuse.
  • What they want their families to be aware of.

Upon concluding this learning experience, learners will acquire a deeper understanding of the importance of advanced directives in healthcare settings.

The resources will aid learners gain proficiency in integrating advanced directives into nursing practice. The goals are to assist with success on the NCLEX examination and in the workplace.

After reviewing the resources, identify areas for improvement and concentrate on those areas.

  • Burke, A. (2023, September 27). Advanced Directives: NCLEX-RN. https://www.registerednursing.org/nclex/advance-directives/
  • Kaplan Nursing. (2023). NCLEX-RN Content Review Guide (9th ed.). Kaplan Test Prep.

The following links do not belong to Tecmilenio University, when accessing to them, you must accept their terms and conditions.

Readings

Videos