8.4 Advance Directives, POLST, and Refusals

Advance Directives And POLST

Advance directives are legal documents about healthcare wishes. POLST stands for Physician Orders for Life-Sustaining Treatment and is used for medical orders about emergency care preferences.

The CNA does not interpret these documents independently. The CNA follows the care plan and nurse direction.

CNA Role

The CNA may:

• Know whether the resident has special care instructions in the care plan.
• Report resident questions to the nurse.
• Respect choices during daily care.
• Report refusal of care.
• Follow emergency procedure.

The CNA should not:

• Explain legal consequences.
• Persuade a resident to choose a code status.
• Change a care plan.
• Tell family what medical decisions to make.
• Ignore a resident's expressed wishes.

Refusals

Residents can refuse care. The CNA response should be calm and respectful.

Try this sequence:

1. Pause and listen.
2. Ask if the resident is uncomfortable, afraid, tired, or in pain.
3. Offer a safe alternative if appropriate.
4. Report to the nurse.
5. Document according to policy.

Emergencies

In an emergency, follow facility policy. If you do not know the resident's code status, call for the nurse and initiate the facility's expected emergency response for your role.

Exam Tip

The CNA answer should respect the resident's choice and involve the nurse. Avoid answers where the CNA gives legal advice, ignores documents, or forces care.