Advance Directives And Surrogate Decision-Making - NCLEX-RN

Assess for the document and ensure it is in the medical record. Nursing standards require verifying and documenting advance directives to ensure they are accessible and can guide care decisions appropriately.

Honor the patient’s stated wishes (autonomy). The ethical principle of autonomy prioritizes respecting the patient's expressed wishes in advance directives to guide end-of-life care.

That it is valid, available, and applicable to the current situation. Verification ensures the directive is legally sound, readily accessible, and relevant to the patient's current clinical circumstances before implementation.

Respect the refusal after ensuring informed decision-making. Respecting informed refusal upholds patient autonomy and ethical standards, provided the patient understands the risks and benefits.

The patient’s current competent choice overrides prior directives. Current competent decisions reflect the most up-to-date expression of autonomy, superseding outdated directives that may no longer align with wishes.

A medical order to withhold CPR if cardiac or respiratory arrest occurs. DNR orders prevent unwanted resuscitation attempts, aligning with patient autonomy in end-of-life care preferences.

A provider order (per facility and state policy). Legal and facility protocols mandate a provider's order to implement DNR, ensuring it reflects informed discussions rather than family requests alone.

Focus on comfort; do not initiate CPR during arrest. AND emphasizes palliative care and natural progression, explicitly excluding CPR to honor patient wishes for comfort-oriented end-of-life management.

All appropriate care except CPR during arrest. DNR specifically limits CPR but allows other interventions to manage symptoms and maintain quality of life unless otherwise specified.

Follow the patient’s directive and notify the provider/ethics as needed. Prioritizing the valid directive upholds patient autonomy, with escalation to ethics or providers resolving conflicts ethically and legally.

Presumed consent for emergency care when the patient cannot consent. Implied consent protects patients in urgent situations by assuming they would want life-saving interventions when unable to provide explicit consent.

Provide emergency stabilization while seeking surrogate/documentation. Emergency protocols prioritize stabilization to preserve life while simultaneously pursuing legal surrogates or documents to guide ongoing care.

Surrogate chooses based on what the patient would have wanted. This standard requires surrogates to base decisions on the patient's known values and preferences, promoting authenticity in representation.

Surrogate chooses the option that best promotes the patient’s welfare. When wishes are unclear, this standard guides surrogates to select options that objectively maximize the patient's overall well-being and quality of life.

Durable power of attorney for health care. Unlike a living will, which specifies treatment preferences, a durable power of attorney legally appoints a proxy to interpret and apply the patient's wishes.

Substituted judgment. Substituted judgment is prioritized as it most closely honors patient autonomy by approximating what the individual would decide if able.

To name a health care agent to make decisions if incapacitated. This document upholds patient autonomy by designating a trusted individual to make health care decisions aligned with the patient's values when incapacitated.

To document desired or refused life-sustaining treatments. A living will ensures patient autonomy by clearly outlining specific medical interventions to be administered or withheld in terminal conditions.

A legal document stating future health care wishes if incapacitated. Advance directives empower patients to maintain autonomy by specifying preferences for medical treatment when they lack decision-making capacity.

Best-interest standard. Without known wishes, the best-interest standard provides an objective framework to evaluate benefits, burdens, and quality of life for decision-making.

Advocate for the patient and consult provider/ethics per policy. Nurses act as patient advocates by identifying potential misalignments and involving interdisciplinary teams to ensure decisions reflect patient values.

Portable medical orders reflecting current goals for serious illness. POLST/MOLST translates patient goals into transferable orders, facilitating consistent care across settings for those with advanced illnesses.

POLST/MOLST (it is a set of actionable medical orders). As medical orders, POLST/MOLST provide specific, immediate directives that supersede broader living wills in guiding acute care decisions.

Do not initiate CPR; follow the DNR and notify the provider immediately. Valid DNR orders must be followed to respect patient autonomy, with immediate provider notification to address family concerns ethically.