Situation: Fatima, a 78-year-old woman with end-stage heart failure, is admitted to the medical-surgical unit following an acute decompensation. Background: She has been hospitalized three times in the past four months and her ejection fraction is 15%. Assessment: She is alert and oriented, but reports she is "tired of fighting" and does not want to be resuscitated if her heart stops. Her daughter, who holds durable power of attorney, insists the team do "everything possible." Recommendation: The care team requests nursing input before the goals-of-care meeting. The nurse reviews the chart and finds no advance directive on file. Which action should the nurse take first?
- Document Fatima's verbal wish not to be resuscitated in the nursing notes and notify the primary health care provider.
- Facilitate a goals-of-care conversation that includes Fatima, her daughter, and the primary health care provider to document Fatima's stated wishes.
- Follow the daughter's wishes because she holds durable power of attorney.
- Defer all decision-making to the daughter until a formal advance directive is signed.