Question

The wife of your 75-year-old client comes to you with the concern that her husband has decided to make himself a DNR in his advance directives and does not wish to be resuscitated if his heart stops or he stops breathing. He was diagnosed in early stages of dementia last year, and she is afraid that he is "not in his right mind" to be able to make this decision What would you share with the wife in regard to his rights in the advance directives decisions? How can the nurse help the wife in this situation?

Answer 1

An advance directive is a group of instructions stating a person's wishes relative to his health care if he were incapacitated or unable to make that decision. It is quite common that people think that once an advance directive is signed, no further care will be provided. I will make the wife understand that this is not the case;instead, the directive is to make sure that they will get however much or little care they wish. According to ANA recommendation concerning DNR are

• The competents patients choices have highest priority when there is conflict.
• When the patient is not competent, give highest priority to advance directive or the surrogate decision makers.
• DNAR orders should be discussed explicitly with the patient and significant others.
• DNAR orders must be documented, reviewed and updated.
• DNAR order does not mean discontinue care.
• If the DNAR order compromises your moral integrity, transfer the patients care to another nurse.

The nurse can help the client by discussing advance directive with the client opens the communication channel to establish what is important to the client and what the client may view as promoting life versus prolonging dying. The nurse needs to ensure that the client has provided with information about the right to identify written directions about the care that the client wishes to receive.