Advance Directive in NJ defined how to do and use at The Stone Center

1. Advance DirectiveAdvance Directive
Eneida Cruz, DNP, RN

2. Advance DirectiveAdvance Directive
 A legal document that you can complete on your
own that can help ensure your preferences for
various medical treatments are followed if you
become unable to make your own healthcare
decisions.
 Your advance directive only goes into effect if
your physician has evaluated you and determined
that you are unable to understand your diagnosis,
treatment options or the possible benefits and
harms of the treatment options.
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Advance Directive OverviewAdvance Directive Overview
A document or documentation
allowing a person to give directions
about future medical care or to
designate another person(s) to make
medical decisions if the individual
loses decision-making capacity.

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Advance Directive includes:Advance Directive includes:
Living wills
Durable power of attorney
Do not resuscitate (DNRs) orders
Right to die, or
Similar documents expressing the
individual’s preferences

5. New Jersey Advance DirectiveNew Jersey Advance Directive
NJ has 2 kinds of advance directives
– Instruction Directive (Living Will)
 An instruction directive is a document you use to tell your
physician and family about the kinds of situations you
would want or not want to have life-sustaining treatment in
the event you are unable to make your own healthcare
decisions.
– Proxy Directive (Durable Power of Attorney for
Healthcare)
 A proxy directive is a document you use to appoint a
person to make healthcare decisions for you in the event
you become unable to make them yourself.
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Why do I need an Advance Directive?Why do I need an Advance Directive?
 Advance directive gives you a voice in
decisions about your medical care when you
are unconscious or too ill to communicate.
 If you are able to express your own
decisions your advance directive will not be
used and you can accept or refuse any
medical treatment.
 If you become seriously ill, you may lose
the ability to participate in decisions about
your own treatment.

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Patient Self-Determination ActPatient Self-Determination Act
Is a federal law that requires health
care facilities that receive Medicaid
and Medicare funds to inform patients
of their rights to execute Advance
Directives.

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New Jersey Advance DirectiveNew Jersey Advance Directive
 NJ has 2 kinds of advance directives
– Proxy Directive (Durable Power of Attorney for Health Care)
 A document you use appoint a person to make health care
decisions for you in the event you become unable to make
them yourself.
– Instruction Directive (Living Will)
 A document you use to tell your physician and family about the
kinds of situations you want or not want to have life-sustaining
treatment in the event you are unable to make your own
healthcare decision. You can also include a description of your
beliefs, values, and general care and treatment preferences.
This will guide your physician and family when they have to
make healthcare decisions for you in situations not specifically
covered by your advance directive.

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How do I make my AdvanceHow do I make my Advance
Directive legal?Directive legal?
The law requires that you have your
Advance Directive witnessed. You can
do this in either or two ways:
– Sign your document in the presence of
two witnesses
– Sign you document in the presence of a
lawyer or notary public

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Advance DirectiveAdvance Directive
Policy A.48.APolicy A.48.A
Nursing Responsibilities
–Pre-Procedure Call
–Pre-Procedure Check List
–Notify the Urologist and
Anesthesiologist
Patient Representative
Responsibilities
– Medical Record
– Contact UH

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Advance DirectiveAdvance Directive
Policy A.48.A, cont’dPolicy A.48.A, cont’d
Physician Responsibilities
(Urologist and/or Anesthesiologist)
– Medical Record
– Ethical Conflict
– Transfer of care

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Advance Directive PlanningAdvance Directive Planning
 Knowing that an
Advance Directive
has already been
discussed and
decided upon relieves
the stress already
created from
responding to an
emergency situation.

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Patient AwarenessPatient Awareness
A patient with an Advance Directive that
includes a DNR directive will be notified
during the Pre-Procedure Phone Call that it
is not effective while at The Stone Center.

14. FAQ’sFAQ’s
 Do I need a lawyer to complete an advance directive?
– No, you can complete an advance directive on your own.
 Can I change or cancel my advance directive?
– Yes, you can change it by completing a new one and you can
cancel it by telling your physician, family, healthcare
representative, or reliable witness.
 Does my advance directive have to be notarized?
– No
 Is there anyone who cannot sign my advance directive as
a witness?
– Yes, the person who you appoint as your healthcare
representative cannot be a witness.
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