Nurses and the importance of DNR.
I remember a patient I had as a brand new nurse who was marked “do not resuscitate,” or “DNR.” The patient suffered intracranial bleeding, and as a result of his advanced age and terminal cancer, his family agreed that cardiopulmonary resuscitation shouldn’t be performed. I remember the nursing supervisor asking me why the patient wasn’t wearing a footrest and foam heel protectors (which we did back then); I replied that he was a DNR patient. She mainly handed me the pinnacle and said his DNR status had nothing to do with good nursing care.
I even have never forgotten this incident, and once I spoke with the authors of a mixed-methods study of direct care nurses on three different units that found that “different interpretations of DNR orders are common among nurses,” I immediately agreed. Their article is an original research article in ALLJanuary issueNursing perspectives on the care of patients who’ve been advised to not resuscitate“
Families and providers may understand DNR in another way.
And it isn’t just nurses who can have different ideas and think in another way about what should and should not be done for patients who’re teetering between life and death – other healthcare professionals and families should be clear about what this designation means for the extent of care the patient will receive. If everyone isn’t on the identical level of understanding the importance of DNR, misconceptions could cause communication problems and exacerbate tensions in an already difficult situation.
DNR doesn’t mean withdrawal of care.
I remember a family who didn’t speak much English but said through a translator that they “wanted everything to be done” for his or her mother, who was in her 90s, with cognitive impairment and advanced heart disease that caused frequent episodes of ventricular fibrillation. This meant repeated interventions including cardiopulmonary resuscitation and repeated defibrillation – so often that we kept a cart of codes next to her bed. We finally discovered that the family thought that in the event that they told us to not do all the pieces, it meant we would not do it Allthat their beloved mother can be left to die.
You can watch A video summary by certainly one of the co-authors, however the message is obvious:
“It is very important to understand that DNR orders are not a substitute for care plans.”
