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Advance Directives and Do-Not-Resuscitate Orders

Author: Noah Carpenter, MD and Dana Bartlett, RN, BSN, MSN, MA, CSPI

CE: 2 hours
Rated 4.7 out of 5.0 based on 50594 reviews

Course Summary

A person may sustain an unexpected medical event, or acquire a progressive disease that causes a decline in the person’s health or function. These events may limit a person’s cognition to the point that he or she can no longer make healthcare decisions. An advance directive may be created in advance of these medical events so that a person’s preferences regarding medical care can be known ahead of time, and implemented even though the patient can no longer state his or her wishes. There are different types of advance directives, each having its particular function, as well as potential advantages and disadvantages. Health clinicians need to know how each of these directives are created and how they work. Health clinicians also need to know how each of these directives function when the time comes to use them. It is not always simple to implement a patient’s advance directive since conflicts may arise when a coworker or family member disagrees on the application of a patient’s advance directive or the medical care that should be given to the patient. These conflicts may be resolved by bringing together family and health team members into the decision process for carrying out the patient’s wishes.

Course Format


Course Syllabus

I.    Introduction

II.    Prevalence of Advance Directives

III.    Scenarios Involving the Use of Advance Directives

1. Scenario 1: Elderly Man with Cancer
2. Scenario 2: Elderly Woman with Advanced Dementia
3. Scenario 3: Elderly Woman with a Stroke
4. Scenario 4: An Oncology Patient

IV.    Common Types of Advance Directives

1. Do-Not-Resuscitate Orders (DNR)
2. Living Will
3. Medical Power of Attorney
4. Physician Orders for Life-sustaining Treatment (POLST)
5. Instructional Directive
6. Consulting an Attorney

V.         Choosing a Health Care Agent

VI.    Using an Advance Directive

1. Communicating the Advance Directive to Others
2. When an Advance Directive is Activated

VII.         Changes to Advance Directives

VIII.         Medical Treatments to Consider

1. Resuscitation
2. Mechanical Ventilation
3. Nutrition and Hydration
4. Hemodialysis
5. Comfort Care
6. Organ Donation

IX.         Barriers to End-Of-Life Care

X.         Advance Directives and Resolving Conflicts

XI.         Case Study 1


XII.    Case Study 2

XIII.    Conversations About Patient Goals and General Preferences

XIV.    Future Directions of Advance Directive and DNR Policy

XV.    New Directions During COVID-19 Pandemic

XVI.    Summary


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