What is the difference between an advance directive and a DNR, and how should nurses handle patient wishes in practice?

• A. DNR documents future care preferences; Advance directive indicates no resuscitation; skip discussion and follow orders.
• B. Advance directive documents future care preferences; DNR indicates no resuscitation; verify documents, discuss with patient/family, ensure care aligns with wishes.
• C. Advance directive is only for minors; DNR for adults; disregard patient autonomy.
• D. DNR is a general consent form; advance directive is location-specific; interpret without verifying.

Answer: (B)

Understanding how patients want their care to proceed when they can’t speak for themselves is the key here. An advance directive is a document that lays out a person’s future care preferences for a range of treatments and outcomes, and it may also designate a durable power of attorney for healthcare to make decisions if the person becomes unable to do so. A DNR, on the other hand, is a specific order about whether cardiopulmonary resuscitation should be attempted if the patient stops breathing or their heart stops.

In practice, the nurse’s role is to verify that these documents exist and are current, discuss them with the patient and/or family to understand the exact wishes, and ensure that the care provided matches those wishes. This means communicating with the medical team, following the official orders, and documenting clearly. If the patient lacks capacity, decisions should follow the designated surrogate or the advance directive as permitted by policy, and care should be reassessed as conditions change. It’s about honoring patient autonomy and ensuring that all actions align with the stated preferences, while still providing appropriate care within those limits.