Page 45 - Essentials of Nursing Leadership and Management, 5th Edition

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32 unit 1 | Professional Considerations CikguOnline
if you are walking down the hall after your surgery Through this mechanism, families can be spared
and your heart stops beating, you do not want the the burden of having to decide what the family
nurses or physicians to do anything? You want us to member would have wanted.
just let you die?” Mrs. Vincent responded with a Federal law requires that health-care institu-
resounding, “No, that is not what I mean. I mean if tions that receive federal money (from Medicare,
something happens to me and I won’t be able to be for example) inform clients of their right to create
the way I am now, I want to be a DNR!”The nurse advance directives.The Patient Self-Determination
then explained the concept of a DNR order. Act (S.R. 13566) provides guidelines for develop-
ing advance directives concerning what will be
New York state has one of the most complete laws
done for individuals if they are no longer able to
regarding DNR orders for acute and long-term
participate actively in making decisions about care
care facilities. The New York law sets up a hierar-
options. The act states that institutions must:
chy of surrogates who may ask for a DNR status for
incompetent clients.The state has also ordered that ■ Provide information to every client. On
all health-care facilities ask clients their wishes admission, all clients must be informed in
regarding resuscitation (Guido, 2001). The ANA writing of their rights under state law to accept
advocates that every facility have a written policy or refuse medical treatment while they are com-
regarding the initiation of such orders (ANA, petent to make decisions about their care. This
1992). The client or, if the client is unable to speak includes the right to execute advance directives.
for himself or herself, a family member or guardian ■ Document. All clients must be asked whether
should make clear the client’s preference for either they have a living will or have chosen a durable
having as much as possible done or withholding power of attorney for health care (also known as
treatment (see the next section,Advance Directives). a health-care surrogate). The response must be
Elements to include in a DNR order are listed indicated on the medical record, and a copy of
in Box 3-3. the documents, if available, should be placed on
the client’s chart.
Advance Directives
■ Educate. Nurses, other health-care personnel,
The legal dilemmas that may arise in relation to and the community need to understand what
DNR orders often require court decisions. For this the Patient Self-Determination Act and state
reason, in 1990 Senator John Danforth of Missouri laws regarding advance directives require.
and Senator Daniel Moynihan of New York intro- ■ Be respectful of clients’ rights. All clients are to
duced the Patient Self-Determination Act to be treated with respectful care regardless of their
address questions regarding life-sustaining treat- decision regarding life-prolonging treatments.
ment. The act was created to allow people the ■ Have cultural humility. Recognize that culture
opportunity to make decisions about treatment in affects clients’ decisions regarding end-of-life
advance of a time when they might become unable care. Nurses should familiarize themselves with
to participate in the decision-making process. the cultural and spiritual beliefs of their clients
in order to deliver culturally sensitive care.

box 3-3
Living Will and Durable Power of Attorney
Elements to Include in a DNR Order for Health Care (Health-Care Surrogate)
• Statement of the institution’s policy that resuscitation The two most common forms of advance directives
will be initiated unless there is a specific order to are living wills and durable power of attorney for
withhold resuscitative measures
• Statement from the client regarding specific desires health care (health-care surrogate).
• Description of the client’s medical condition to justify a A living will is a legally executed document that
DNR order states an individual’s wishes regarding the use of
• Statement about the role of family members or significant life-prolonging medical treatment in the event that
others he or she is no longer competent to make informed
• Definition of the scope of the DNR order
• Delineation of the roles of various caregivers treatment decisions on his or her own behalf and is
suffering from a terminal condition (Catalano,
American Nurses Association. (1992). Position statement on nursing care and
do not resuscitate decisions. Washington, DC: ANA. 2000; Flarey, 1991).