Advance Directive

1. Advance DirectiveAdvance Directive
Eneida Cruz, DNP, RN

2. Advance DirectiveAdvance Directive
 A legal document that you can complete on your
own that can help ensure your preferences for
various medical treatments are followed if you
become unable to make your own healthcare
decisions.
 Your advance directive only goes into effect if
your physician has evaluated you and determined
that you are unable to understand your diagnosis,
treatment options or the possible benefits and
harms of the treatment options.
The Stone Center of New Jersey
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3. The Stone Center of New Jersey
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Advance Directive OverviewAdvance Directive Overview
A document or documentation
allowing a person to give directions
about future medical care or to
designate another person(s) to make
medical decisions if the individual
loses decision-making capacity.

4. The Stone Center of New Jersey
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Advance Directive includes:Advance Directive includes:
Living wills
Durable power of attorney
Do not resuscitate (DNRs) orders
Right to die, or
Similar documents expressing the
individual’s preferences

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Why do I need an Advance Directive?Why do I need an Advance Directive?
 Advance directive gives you a voice in
decisions about your medical care when you
are unconscious or too ill to communicate.
 If you are able to express your own
decisions your advance directive will not be
used and you can accept or refuse any
medical treatment.
 If you become seriously ill, you may lose
the ability to participate in decisions about
your own treatment.

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Patient Self-Determination ActPatient Self-Determination Act
Is a federal law that requires health
care facilities that receive Medicaid
and Medicare funds to inform patients
of their rights to execute Advance
Directives.

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New Jersey Advance DirectiveNew Jersey Advance Directive
 Proxy Directive (Durable Power of Attorney for Health
Care)
– A document you use appoint a person to make health care
decisions for you in the event you become unable to make
them yourself.
 Instruction Directive (Living Will)
– A document you use to tell your physician and family about
the kinds of situations you want or not want to have life-
sustaining treatment in the event you are unable to make your
own healthcare decision. You can also include a description of
your beliefs, values, and general care and treatment
preferences. This will guide your physician and family when
they have to make healthcare decisions for you in situations
not specifically covered by your advance directive.

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How do I make my AdvanceHow do I make my Advance
Directive legal?Directive legal?
The law requires that you have your
Advance Directive witnessed. You can
do this in either or two ways:
– Sign your document in the presence of
two witnesses
– Sign you document in the presence of a
lawyer or notary public

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Advance DirectiveAdvance Directive
Policy A.48.APolicy A.48.A
Nursing Responsibilities
–Pre-Procedure Call
–Pre-Procedure Check List
–Notify the Urologist and
Anesthesiologist
Patient Representative
Responsibilities
– Medical Record
– Contact UH

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Advance DirectiveAdvance Directive
Policy A.48.A, cont’dPolicy A.48.A, cont’d
Physician Responsibilities
(Urologist and/or Anesthesiologist)
– Medical Record
– Ethical Conflict
– Transfer of care

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Advance Directive PlanningAdvance Directive Planning
 Knowing that an
Advance Directive
has already been
discussed and
decided upon relieves
the stress already
created from
responding to an
emergency situation.

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Patient AwarenessPatient Awareness
A patient with an Advance Directive that
includes a DNR directive will be notified
during the Pre-Procedure Phone Call that it
is not effective while at The Stone Center.