The nurse is admitting a new client to the medical unit. When asked about advance directives, the client says, “I’m not really sure what that is, but I trust my doctor to do whatever he thinks I need.” Which is the correct action by the nurse?

  1. tell the client not to worry about it, because the client can always add the advance directives later
  2. tell the client that she can pay her lawyer to draw one up and have a copy sent to the hospital
  3. explain what advance directives are and how they benefit the client, and offer to give the client a copy so she can read it and ask questions
  4. omit further discussion about advance directives, and chart that the client does not have one and refuses further information
Number 3 is correct.
The Patient Self-Determination Act of 1990 requires that all clients of health care facilities be informed of their right to refuse care or specify their wishes should they become unable to speak for themselves. Giving the client a copy to read allows the nurse to answer questions and explain that the client may choose which interventions she does or does not want. For example, a client may refuse to be on a ventilator but will accept tube feedings for nutrition. If the client fills out the advance directives, it should be witnessed by two nonfamily members or other neutral parties and placed on the client’s chart. While the directives can be added later, the nurse should not tell the client not to worry about it. The directives may be forgotten, and should an emergency arise, the client will not have as much autonomy in her care. Advance directives do not need to go through a lawyer in most cases, and waiting to have them drawn up and sent causes unnecessary delays for the client. The nurse should never simply drop the discussion and chart that the client refused them. The nurse is duty bound to make the client fully aware of all of her rights. It is important to avoid any actions that may endanger a client or lead to potential legal action.