| How much do your nursing assistants know about | | | | important for people to discuss their end-of-life |
| advance directives? Are they aware of the | | | | wishes with whomever they choose as their HCPOA. |
| difference between a living will, a health care power | | | | Good communication helps ensure that those wishes |
| of attorney and a DNR order? Do they know that all | | | | will be honored when the time comes. |
| clients must be asked about advance directives...and | | | | Remember that clients who have completed a |
| must be given the opportunity to create one? To | | | | HCPOA form have not given up the right to make |
| make sure that your CNAs understand the basics, | | | | their own medical decisions. A HCPOA takes charge |
| consider giving them the following important | | | | only if and when clients are unable to communicate |
| information: | | | | their own wishes. |
| What Is an Advance Directive? | | | | What Is a DNR Order? |
| As a health care worker, you've probably heard the | | | | Advance directives give important directions for |
| term "advance directive". But, what is an advance | | | | medical care, but to be official, a person's wishes |
| directive anyway? It is a document that outlines | | | | need to be put into medical orders. An important |
| people's preferences for medical care when, in the | | | | medical order that many people want when they are |
| future, they are unable to communicate their wishes. | | | | very old and/or terminally ill is a Do Not Resuscitate |
| It is particularly useful when someone is terminally ill, | | | | order. |
| critically ill or has advanced Alzheimer's disease. | | | | A Do Not Resuscitate order tells medical |
| Advance directives are not just for people who are | | | | professionals to suspend action even if someone's |
| sick or old. Advance directives are something that all | | | | heart and breathing stops. This means that doctors, |
| people should consider having. Keep in mind that | | | | nurses and emergency medical personnel will not use |
| having an advance directive is not a sign that | | | | emergency CPR to try to revive someone. |
| someone has given up on life since it takes effect | | | | DNR orders are designed to help people who are in |
| only when people can no longer communicate their | | | | the final stages of a terminal illness, who suffer from |
| own wishes. | | | | a chronic serious condition, or who are old and ready |
| REMEMBER: Advance directives give people a voice in | | | | to die. Often, the process of establishing a DNR |
| their own medical decisions even after they have lost | | | | order helps people begin to come to terms with |
| the ability to speak for themselves. | | | | death-whether it is their own or the death of a loved |
| What Is a Living Will? | | | | one. |
| A living will contains written instructions detailing a | | | | DNR orders must be signed and dated by a physician. |
| person's wishes for end-of-life care to family | | | | They may be written for people in hospitals, nursing |
| members and to doctors. These wishes might include | | | | homes, assisted living facilities-and, in most states, for |
| preferences about: | | | | people living in their own homes. |
| - CPR | | | | Generally, paramedics working in the community have |
| - Tubes to provide nutrition and/or hydration | | | | a duty to perform CPR when a person's heart or |
| - Kidney dialysis | | | | breathing stops. For people still living at home, many |
| - Ventilators | | | | states have a special DNR order-called a "Prehospital |
| - Blood transfusions | | | | DNR", an "Out-of Hospital DNR" or a "Portable DNR". |
| - Invasive procedures | | | | If you are a home health aide, you may see one of |
| - Pain medication | | | | these forms. It is usually written on brightly colored |
| - Surgery | | | | paper and should be posted in an obvious place so |
| - Organ transplantation | | | | that the paramedics know not to resuscitate the |
| - Chemotherapy | | | | person. |
| - Antibiotics | | | | Some states have portable DNR bracelets that alert |
| - Dying at home or at a medical facility | | | | paramedics that a DNR order has been written by |
| A living will becomes effective when it is determined | | | | the person's physician. |
| that a person can no longer make his or her own | | | | A Final Word about Advance Directives |
| decisions. As long as the requests in the living will are | | | | As medical technology has become more advanced |
| legal (and don't go against reasonable medical | | | | over the years, doctors have been able to keep |
| standards), doctors will usually honor them. | | | | people alive longer and longer. Many people have |
| Living wills must be signed and dated. They must also | | | | wanted to say "enough is enough"! This is where |
| be signed by two witnesses. Health care workers | | | | advanced directives come in. Living wills and health |
| should never be witnesses to a living will! If a client | | | | care powers of attorney give people control over |
| asks you to be a witness, explain that it's against | | | | what happens to them. |
| your workplace policy. | | | | There are both federal and state laws about |
| What Is a Health Care Power of Attorney? | | | | advance directives. The federal law, the Patient |
| The second kind of advance directive has a few | | | | Self-Determination Act (PSDA), took effect in |
| different names, depending on your state. For | | | | December of 1991. It requires that patients/clients |
| example, you may hear it called a health care power | | | | residents must: |
| of attorney (HCPOA, for short) or a health care | | | | - Be asked if they have advance directives on |
| proxy or a health care agent. | | | | admission to a health care organization. |
| A HCPOA is a legal document that names a particular | | | | - Be informed of their rights to refuse treatment and |
| person to be in charge of future medical decisions. | | | | to prepare advance directives. |
| Many people choose their spouse or an adult child to | | | | - Have documentation of their advance directive |
| serve as their health care power of attorney. Other | | | | status in their charts. |
| people choose a close family friend or even a lawyer. | | | | - Have their advance directives honored. |
| It is against the law for physicians or other health | | | | In addition, all health care organizations (that accept |
| care employees to act as HCPOA for their patients. | | | | Medicare and/or Medicaid funding) must have a policy |
| For example, Mr. Stone lives in a skilled nursing facility. | | | | on advance directives. This policy must be available in |
| He has a favorite nurse, Marsha, with whom he has | | | | writing to all people who are admitted to the facility |
| discussed his end-of-life wishes. He says he trusts her | | | | agency. And, all staff members must be taught about |
| the most and wants her to be his health care power | | | | advance directives. |
| of attorney. Marsha knows this is against the rules so | | | | The public needs to know that it is a federal |
| she asks the social worker to discuss the matter | | | | requirement that healthcare workers ask about |
| with Mr. Stone. The social worker helps Mr. Stone | | | | advance directives. By doing so, you support the |
| choose an appropriate person to be his HCPOA. | | | | rights of every client to be involved in decisions |
| The idea is that the person named in a HCPOA will | | | | regarding their medical care-whether it concerns a |
| make the same decisions that the patient would | | | | simple procedure or the end of life. |
| have made if he or she were able. It is very | | | | |