A client with Amyotrophic Lateral Sclerosis (ALS) tells the hospice nurse they do not want to be intubated and placed on mechanical ventilation. How should the nurse best respond?

Addressing end of life care for patients with neurodegenerative diseases requires therapeutic communication and clarification of advance directives. The nurse must apply principles of patient advocacy and ethics to ensure that specific treatment preferences are understood and documented for future implementation. Choice A rationale While the healthcare provider must be informed, this response shifts the responsibility away from the nurse at a critical moment of sharing. The nurse should first explore the patient preferences to provide comprehensive support and advocate for their wishes. Choice B rationale This open ended question facilitates an exploration of the patient values and specific desires for comfort care. It allows the nurse to document alternative interventions, such as morphine or oxygen, while respecting the patient refusal of invasive life support. Choice C rationale An incentive spirometer helps with lung expansion but will not prevent the ultimate neuromuscular respiratory failure associated with ALS. Giving false hope about delaying ventilation is nontherapeutic and ignores the patient expressed desire to avoid intubation entirely. Choice D rationale Asking why can be perceived as defensive or judgmental in therapeutic communication. It may make the patient feel they need to justify their choice, rather than allowing them to express their feelings and plan for their end of life..