Advanced Directives

Nurses General Nursing

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I am a nursing student doing a paper on Advanced Directives, honoring patients wishes, and dealing with family members who may not agree or are having difficulty with this. Any comments or insights, personal experiences, etc that you may contribute would be very helpful and greatly appreciated!!! Thanks so much! Jacquie

In my experience, if a patient has an advance directive, lets say no CPR, and the family does not agree with it and the pt cannot speak for themeselves, the doctors will go with the families wishes. I have even seen a doc go with the families wishes with a pt that was alert and oriented and verbalized that she did not wish to have CPR, the doc went with the daughter who said that she did want mom to get CPR.

Advance Directives and living wills and DNR's are only good if the family is aware of and agrees with the pts wishes.

I've seen all kinds of crazy situations involving advance directives. I've witnessed family members freak out when their loved one dies (of terminal cancer)and demand he be resuscitated, even though they had previously agreed to a DNR. I've seen MD's refuse to make a patient a DNR even though the patient wants to be one, either because the MD has particular religious beliefs or just can't bring himself to do it. I've also seen cases like these taken before the hospital ethical committee because an agreement cannot be reached. Whatever the situation, I think it's important not only to discuss your wishes with your family, but also to make sure they'd feel comfortable carrying them out.

i have also had issues with advanced directives, patients and their families. unless all are in agreement on the end of life decisions; there usually is a situation that arises with death does come. we had an issue last week that the daughter of the patient who could not speak for herself wanted DNR, but the son of the patient didn't. it's still being discussed this week. so we wait and hope that when the decision is made that all are in agreement, and someone doesn't change their mind in the last minute.

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