NCOA

Patient Autonomy and Decision Making in Healthcare

  • Patient's Age and Autonomy

    • The age of a patient, such as being 95 years old, does not undermine their autonomy.

    • If a patient is "alert and oriented times four," they have the right to make decisions regarding their treatment, including whether to be a Do Not Resuscitate (DNR) patient.

    • The patient's choices must be respected despite contrary opinions from family members, such as a daughter stating otherwise.

  • Patient's Orientation

    • Orientation involves the patient's awareness of self, time, place, and situation.

    • If the patient is alert but not fully oriented, external parties (i.e., family or healthcare proxies) may decide the patient's treatment protocols.

Patient Rights and Directives

  • Patient Self-Determination Act

    • Protects a patient's right to accept or refuse treatment and to provide advance directives.

    • Nurses have key responsibilities including:

    • Education regarding advance directives.

    • Proper documentation of patients' decisions.

    • Advocacy for the patient's expressed wishes.

  • Advance Directives

    • A signed document that outlines a patient's healthcare preferences in case they are unable to communicate them later.

    • Essential for ensuring that patients’ wishes are honored, especially in emergencies or severe illness.

  • Types of Directives

    • DNR (Do Not Resuscitate): Indicates a patient does not wish to receive resuscitative measures.

    • PNR (Physician’s Notes Request) or PAST Directives: Indicates general refusals of certain kinds of treatment or interventions.

    • Always ensure the patient’s directive is readily available in their medical chart and also provide copies to the healthcare facility if the patient is transferred.

Decision-Making and Changes in Wishes

  • Changes in Patient’s Wishes

    • It's crucial to update the patient’s directives immediately if they change their mind about treatment preferences, especially at the moment they communicate this change.

    • If a patient initially indicated DNR but later requests CPR, it must be documented and acted upon without delay.

  • Legal and Ethical Responsibilities

    • Nurses must ensure their actions reflect the patient's current wishes to avoid legal implications like potential court cases.

    • When a patient expresses a change of wish during care (e.g., to receive aggressive treatment), prompt updates in documentation and communication to the care team are essential.