Advance care planning in nursing: get the client's wishes into the plan
Ask, get the paper, tell the team, and match the plan. When a family disagrees with the wishes, listen, promise nothing, and escalate.
- Wishes that stay at home can't guide anyone.
- Ask, get the paper, tell the team, and match the plan.
- A family disagreement is never yours to settle. Escalate it.
In advance care planning, the nurse's part is to get the client's wishes into the plan of care before the day they are needed: ask, get the paper, tell the team, and match the plan. When a family disagrees with the wishes, you listen, promise nothing and escalate. This guide follows one client from the day she arrives.
A son asks you to forget the papers
A man stops you in the hall. “I'm her son. Forget the papers, and start the feeding tube today.” His mother is eighty-four and was admitted with pneumonia. Today she is too drowsy to decide, and she can't swallow safely.
You know what she wanted, because of what you did on the day she arrived.
On the first day: four steps
On the day she arrived, she told you, “My daughter has my papers.” Wishes that stay at home can't guide anyone.
| Step | What you did |
|---|---|
| 1. Ask | You asked who would speak for her. |
| 2. Get the paper | You asked her daughter to bring the papers that afternoon. They name the daughter to decide, and they say no feeding tube. |
| 3. Tell the team | You put a copy in the record, and you told the team. |
| 4. Match the plan | You checked that the orders and the plan of care agreed with her wishes. |
When an order and the recorded wishes do not match, stop and report the gap.
When the family disagrees
So now you listen to her son. You don't promise, and you don't argue. The papers name the daughter, so she speaks for your client, and she must follow what her mother wrote.
Escalate: a family disagreement is not yours to settle
- Tell the charge nurse and the prescriber now.
- Say who asked, and what the papers say.
- The prescriber meets the family.
- Offer the son the social worker.
- Document.
The papers and their names differ between provinces. Follow the law of your province and your agency's policy. To know whose words come first, see advance directives in nursing. The whole story is in ethical issues and advance directives in nursing.