When applying both substituted judgment and best interest standards to end-of-life decision making for a patient, the nurse's primary role is to:

Question

1. Tell the proxy what should be done in the best interest of the patient.
2. Establish trust and confidence with the family.
3. Be an advocate and decision maker based on hospital interests.
4. Promote effective communication and decrease conflict.

Answer 1

4
Rationale 1: Telling the proxy what to do does not allow for individual freedom of choice in the management of care based on the patient's wishes. Health care providers should give options and realistic outcomes but leave the decision making to the proxy and/or family.
Rationale 2: Just establishing trust and building confidence in the health care staff's care will not include what the patient's wishes are. Trust and confidence are important to open communication, but they are not the end process. Getting an understanding of the patient's desires should be the ultimate goal of the communication process.
Rationale 3: Patient care is not based on hospital interests. Nursing is focused on the patient's individual needs and concerns. Allowing the proxy to take these considerations into the decision-making process will allow maximum effect to meet the patient's end-of-life needs.
Rationale 4: During decision-making processes, the health care team's goal is to maximize communication and to minimize conflicts in the best interest of the patient based on what the patient would want if able to express his own desires.