In what instance should the decision for DNR or AND be made?

The most appropriate instance for making the decision for a Do Not Resuscitate (DNR) or Allow Natural Death (AND) order is through consultation with the client and family. This approach emphasizes the importance of involving the patient and their loved ones in critical healthcare decisions, particularly those that reflect their values, wishes, and understanding of their medical condition.

Engaging in a discussion with the client and their family allows healthcare providers to assess the patient’s desires regarding their end-of-life care and ensures that the decisions made align with what the patient would want. This collaborative process also helps in addressing any concerns or questions the family might have, fostering a supportive environment during a difficult time.

In contrast, relying solely on the discretion of the nurse, making decisions post-laboratory tests, or following hospital policy without client input would not honor the patient's autonomy or the ethical principle of shared decision-making in healthcare.