You’ve likely heard a family member ask, “Does Mom really want to go back to the hospital if she stops breathing?” or seen a specific form posted on the back of a resident’s door. The answer lies in their health care directives. As a CNA, understanding these legal documents is crucial for advocating for your residents and honoring their wishes when they cannot speak for themselves.
What are Health Care Directives?
Health care directives are legal documents that outline a person’s preferences for medical treatment and end-of-life care. They serve as a written record of a resident’s choices if they become unable to communicate. Common types include a Living Will, which specifies what treatments the person does or does not want, and a Durable Power of Attorney for Health Care, which appoints someone else to make decisions on their behalf.
Why Health Care Directives Matter in Your Daily Care
These directives are the backbone of resident autonomy and dignity. They ensure that the care provided aligns with the resident’s personal values, not just standard medical protocol. For you, this means understanding whether to aggressively pursue treatment or focus solely on comfort. Ignoring or misunderstanding these documents can lead to unnecessary suffering for the resident and ethical dilemmas for the staff.
What You’ll See During Your Shift
You will encounter these directives primarily in the resident’s medical chart, often at the front or in a specific section designated for “Advance Directives.” You might also see visual cues in the room, such as a “DNR” (Do Not Resuscitate) bracelet or a specific colored wristband. During admission or a change in condition, you might observe the nurse reviewing these papers with the family or the appointed healthcare proxy.
“Nurse, I noticed Mr. Henderson’s daughter is very upset about the transfer to the hospital. I checked his chart and saw he has a ‘Limited Treatment’ directive, but I wanted to double-check with you to make sure we are following his exact wishes regarding transport.”
Common Pitfall & Pro Tip
⚠️ Pitfall: Assuming you know a resident’s code status based on their age or how sick they look without checking the actual paperwork.
Pro Tip: Always verify the current code status (Full Code vs. DNR/Comfort Measures Only) at the start of your shift and during report changes. Treat every resident with dignity and comfort, but rely strictly on the documented orders and nurse’s instructions when emergencies arise.
Memory Aid for Health Care Directives
Think of it as “The GPS for Care”:
- Guidance (What they want)
- Protocol (What we follow legally)
- Safety (Protecting their rights)
Just like a GPS guides a driver, these documents guide the healthcare team to provide the exact care the resident requested.
State Test Connection
Expect questions on Resident Rights and Legal/Ethical Behavior. Exams often test your knowledge on who holds the decision-making power (the resident or the proxy) and the importance of respecting these wishes in daily care scenarios.
Related Care Concepts
Understanding health care directives connects directly to DNR (Do Not Resuscitate) orders, living wills, and power of attorney (POA). It is also closely tied to palliative care and hospice care, where the focus shifts from curing to comforting. Knowing the difference between aggressive treatment and comfort care is essential for CNAs in long-term settings.
Quick Reference
✓ Locate documents: Check the chart face sheet or designated advance directive section at the start of the shift. ✓ When to report: If a family member questions the care plan or if documents seem missing/unsigned. ✓ Care reminders: • Never guess a resident’s wishes—verify in the chart. • Treat all residents with high-quality comfort care regardless of code status. • Direct family questions about specific medical decisions to the nurse or charge nurse immediately.
Bottom line: Respecting health care directives is one of the most powerful ways you protect a resident’s dignity. It ensures your care honors the person they are, not just the patient body you are treating.