Role-play to promote comfort in discussing end-of-life decisions The first difficult discussion a nurse has regarding end-of-life decisions

should not occur under stress when a terminally ill patient is pressing the nurse for assistance. Therefore, as part of the educational process, nurses should role-play various case scenarios with one another regarding how to address end-of-life issues and discussions appropriately. The intent of this role-play activity is to increase nurses comfort levels in discussing advance directives. The following case scenarios can guide this role-play activity. Additionally, ask nursing staff to share actual experiences they have encountered when discussing advance directives with patients, and role-play how these situations were handled or could have been handled differently. Note !odify the following case studies according to your states advance directives law and your hospitals policies and procedures. The role-play will allow you to identify the relevant issues and let you experience how you would react to each scenario. "efore the activity, share these cases scenarios with your hospitals legal department to determine how your state law and hospital policies and procedures would be applied. Should the advance directive be followed? #A$% $T&'( $ally )ones, a *+-year-old woman who suffers from chronic obstructive pulmonary disease ,#-.'/, is admitted to the emergency room in respiratory distress. Two years ago, $ally executed an advance directive stating that she did not want mechanical ventilator support. A copy of this advance directive is available in the emergency room ,%0/. $ally is in respiratory distress that becomes progressively worse while she is in the %0. $ally tells the %0 staff she wants everything done to save her life, and then she codes. 1hat is the responsibility of the %0 staff2 $hould the advance directive be followed2 $hould mechanical ventilation be initiated2 3ssue The issue here is whether $ally revoked her advance directive prior to coding when she instructed the %0 staff that she wanted everything done to save her life. To analy4e this issue, consult your state law regarding revocation of an advance directive. "ut remember, informed decisions made by competent adults always trump advance directives. Is the living will legitimate? #A$% $T&'( !r. Todd, a **-year-old man, is admitted to intensive care following a boating accident. !r. Todd is unconscious at admission and remains so. (ou are the nurse assigned to !r. Todd. Although you dont know him, you know his reputation in your community as a very prominent and wealthy business man who has endured much family discord related to fighting over his money. !r. Todds second wife, 5irginia, presents you with a living will that states that !r. Todd does not want any life-saving measures taken on his behalf. 5irginia has been married to !r. Todd for six months. !r. Todds adult son, #harles, overhears the conversation and becomes very angry. #harles states that !r. Todd did not have a living will and that 5irginia is trying to pull 6a fast one to get all the money.7 1hat should the nurse do2 3ssue The issue here is whether the living will presented by 5irginia Todd is valid. 8irst, notify nursing management that there may be a validity concern with !r. Todds living will. The hospital legal department also should be involved. The legitimacy of the living will then should be evaluated within the mandates of state law. The living will should not be implemented until its validity is established.

Editors note: This excerpt was adapted from the book, %vidence-"ased Advance 'irectives A $tudy 9uide for Nurses.