Advance Directive
An advance directive is a legal document that records healthcare wishes, names a healthcare decision-maker, or does both. Common forms include a living will and a durable power of attorney for healthcare.
Exam Tip
Covered providers inform adults of their rights under state law and document whether a directive exists. A living will records wishes, and a healthcare power of attorney appoints an agent. Follow state rules for activation and revocation.
What Is an Advance Directive?
An advance directive is a legal document that communicates a person's wishes regarding medical treatment when they are no longer able to speak for themselves. It helps the care team honor the patient's choices when the document applies under state law.
Advance Planning Documents and Related Medical Orders
| Type | Purpose |
|---|---|
| Living Will | Specifies which treatments the person does or does not want (e.g., mechanical ventilation, tube feeding, CPR) |
| Durable Power of Attorney for Healthcare | Designates a trusted person (healthcare proxy) to make medical decisions on behalf of the patient |
| Do Not Resuscitate (DNR) | A medical order about CPR; distinct from a living will |
| POLST/MOLST | Portable medical orders for seriously ill people; requirements vary by state |
Key Legal and Nursing Points
| Point | Detail |
|---|---|
| Patient Self-Determination Act (1990) | Requires covered providers to give adult patients written information about state-law rights and provider policy. Hospitals provide it at inpatient admission. |
| Decision-making capacity | Follow state requirements for making a valid directive |
| Witness requirements | Follow the applicable state form and law; witness/notary rules vary |
| Revocation | A patient with decision-making capacity can generally revoke the directive. Follow state rules for revocation. |
| Portability | Check whether the document or medical order is recognized in the new setting or state |
LPN/LVN Responsibilities
- Ask patients on admission if they have an advance directive
- Document the existence (or absence) of an advance directive in the medical record
- Notify the RN if the patient wants to create, change, or revoke an advance directive
- Do NOT provide legal advice or influence the patient's decisions
- Ensure the advance directive is accessible in the patient's chart
- Follow the applicable directive, verified orders and facility policy as part of the care plan
Exam Alert
Advance directives fall under the Coordinated Care category on the NCLEX-PN. Know the Patient Self-Determination Act, the difference between a living will and durable power of attorney for healthcare, and that the LPN's role is to document and communicate, not to provide legal counsel.
A living will alone is not automatically a valid DNR order. The CNA communicates wishes to the nurse and follows verified orders and the emergency response policy. Official guidance.
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Patient Advocacy
Patient advocacy is the act of supporting and protecting patients' rights, safety, and best interests within the healthcare system. Nurses serve as patient advocates by ensuring informed consent, protecting patient rights, facilitating communication, and speaking up when patient safety is at risk.
Care Plan (Nursing)
A nursing care plan records a patient's identified needs, measurable goals and nursing interventions. The RN leads nursing care planning, and the LPN/LVN contributes findings and helps develop, implement and update the plan within the applicable scope of practice.
Scope of Practice (Nursing)
Scope of practice defines what a healthcare professional is legally authorized to do. LPN/LVN practice depends on the jurisdiction's nursing laws, the setting, required supervision and the nurse's competence.
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