N108: Transition to the Registered Professional Nurse

N108: Transition to the Registered Professional Nurse Role Study Guide of 171 Informed Consent Every person has the right to either consent (agree) to or refuse healthcare treatment. The law requires that a person give voluntary and informed consent. Voluntary means that no coercion exists and informed means that a person clearly understands the choices being offered. The Patient Self Determination Act (PSDA) In December 1991, the federal Patient Self Determination Act went into effect. Also known as the Danforth amendment, it was created because of society’s fundamental belief in the individual’s right to decide. The PSDA required that on admission to any healthcare service (hospital, long-term care center, or home health agency), Medicare and Medicaid patients are given an opportunity to determine what life-saving or life-prolonging actions they want carried out. The intent of this legislation was to enhance an individual’s control over medical treatment decisions by promoting the use of advance directives. Advance Directives and DNR Advance directives are legal documents that indicate the wishes of an individual with regard to end- of-life issues. This document becomes important when the patient has no quality of life expectation. Advance directives are evidence of the patient’s wishes when he or she becomes incompetent and/or terminal (eg, living will). They become part of the patient record and are examined for content. A power of attorney designates the person who will make decisions for the patient. A medical surrogate or healtcare proxy and a person who has power of attorney can be two different people. Negative, or passive, euthanasia refers to a situation in which no extraordinary or heroic measures are undertaken to sustain life. The concept of negative euthanasia has resulted in what are called “no codes” also designated as do not resuscitate (DNR). The DNR is legal with the consent of the patient. If the patient is unable to consent, a family member must be designated. The ANA made recommendation in 1995 that nurses take an active role in facilitating informed decision making by the client and assist in the role of education, research, and patient advocacy. Health Care Proxy An instrument (or document) that allows a patient to appoint an agent to make health care decisions in the event that the primary individual is incapable of executing such decisions. Living Will This is an advance directive that indicates what an individual wants done regarding treatment or lifesaving measures in the future. If the living will requests that no resuscitation or limited resuscitation efforts be undertaken, the physician must write orders limiting resuscitation in the record. ©2017 Achieve Test Prep Page 69