A living will records a wish. A POLST is a signed order that EMS will honour in a driveway at 0200. A DNR says one thing and one thing only. Run each document against five real situations, decode what a DNR patient still receives, then build a time-limited trial that actually has an endpoint and sequence a ventilator withdrawal in the order that keeps the patient comfortable.
What the patient has
The situation in front of you
Patient Self-Determination Act, 1990. Facilities taking Medicare or Medicaid must ask on admission whether the patient has an advance directive, give information about them, document the answer, and never condition care on having one. That admission question is a nursing responsibility — it is the moment the document gets into the chart instead of staying in a safe deposit box.
Mr Alvarez, 412 — DNR, not DNI, full medical treatmentFor each item, say whether this DNR patient still receives it. The commonest error on a med-surg floor is treating DNR as a global withdrawal order.
Build the trialThe family wants “everything,” the team thinks it is futile, and nobody wants to say no today. A time-limited trial is the honest middle. Switch on every element yours will contain.
Ventilator withdrawalThe surrogate has agreed to withdraw. Put the six steps in the order you would actually do them, top to bottom. One of these, done out of order, is absolutely prohibited.