A community health nurse is leading an advance care planning education session at a senior wellness fair. Which statements about advance directives, POLST forms, and DNR orders are accurate? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
A person with decision-making capacity may revoke or change an advance directive, POLST, or DNR, including by clearly communicating current wishes to the clinical team (Choice 1). A POLST is a clinician-signed portable medical order that translates treatment preferences into actionable orders (Choice 2). An advance directive commonly includes a living will and healthcare power of attorney and guides care when the person loses decision-making capacity (Choice 3). Family-only verbal preferences are not automatically legally binding nationwide and should be documented through the applicable process (Choice 4). A healthcare proxy must follow applicable written directives rather than override them based on personal preference (Choice 5). A DNR limits resuscitation after cardiopulmonary arrest; it does not by itself prohibit fluids, antibiotics, oxygen, or other treatments (Choice 6).
Frame the documents in three layers. Layer 1 — Advance directive: patient-authored, prospective, kicks in only when capacity is lost; combines living will (preferences) plus durable power of attorney (named decision maker). Layer 2 — POLST/MOLST: clinician-signed medical order, immediately effective, portable across hospital/ECF/EMS, designed for seriously ill or frail patients to translate AD preferences into actionable orders covering CPR, ventilation, artificial nutrition, antibiotics, and hospitalization scope. Layer 3 — DNR/AND: a single specific order limiting CPR only; never affects other treatments. Key teaching points: capacity-bearing patient can revoke any of these at any time including verbally; family/proxy cannot override the patient written directives when those directives apply; PSDA mandates hospitals ask about AD on admission; surrogate decision making sequence is patient preferences → substituted judgment → best interest.
Senior wellness fair at a community center. Audience: 35 older adults aged 65 to 88, several with new diagnoses of advanced cancer or heart failure, asking about advance care planning. Nurse presenting a 30-minute educational session followed by individual counseling.
Advance Directive (AD) — Patient-authored document or set of documents (living will plus durable power of attorney for healthcare) describing future treatment preferences and naming a surrogate decision maker; takes effect only when the patient loses decisional capacity
POLST — Physician or Provider Orders for Life-Sustaining Treatment: a clinician-signed, immediately actionable medical order designed for seriously ill or frail patients that addresses CPR, intubation, antibiotics, artificial nutrition, and hospitalization across care settings
Substituted Judgment — Surrogate decision-making standard requiring the proxy to make the choice the patient would have made if able, based on prior expressed values, written directives, and life patterns; best interest is used only when prior preferences cannot be inferred