A dying patient has a DNR (Do Not Resuscitate) Order: What shall you
do?
As
nurses, it is embodied within us to care infinitely for our patients despite
how hard it may seem. That each pain must be eased and each cry must be soothed.
If a client asks you to do everything to save him, surely you’ll do just as
what you are told. Orders shall be carried out and appropriate interventions
shall be given. Medications shall be provided and that vital signs shall be
monitored; doing everything just to help the patient recover from his illness.
These are just the norms in a nurse’s life. It is a nurse’s call to help and
save. However, what if the patient says no towards saving himself? What if he
just wants to stop trying and let fate take its toll on him? What should a
rightful nurse do?
In a medical ward scenario with
typically very ill clients, it’s already a custom to have patients with DNR
orders or “no code” orders in their files. Most of these clients just wish to
leave the earth peacefully without broken ribs or punctured hearts. Some of
them do not wish to be revived just to face dementia or brain injury as a
consequence. It seems harsh to know but yes, this is a fact. DNR order or the
“Do Not Resuscitate” order is somehow advantageous still to the patients who
died. They will be spared from the harmful consequences of resuscitation if
ever they will be revived. And mind you, reviving a pulseless patient isn’t as easy as that shown
in tv.
According
to BBC, resuscitation is only indicated to those clients suffering from cardiac
or respiratory arrest as an attempt to restore the client. However, it is only
done if resuscitation is in accord to the client’s desires or if it is
appropriate clinically. Medical futility shall always be prevented so as not to
give extra damage to the already-suffering client because sometimes, CPR or
cardiopulmonary resuscitation is not always best or appropriate to be given to
a client.
CPR is deemed to have 0% probability of success
in patients with septic shock, pneumonia, metastatic cancer, and acute stroke
(Dr. Braddock, 2012). Hence most likely, these dying patients included in this
bracket are those who are pro-DNR order as stated in their files, given that
they are conscious and have understood enough to sign such waiver. Or perhaps,
if they’re not conscious at all, it would then be the call of the patient’s family
and significant others to decide once and for all.
Since
these patients have already decided to leave without resuscitation, it is the
role of nurses to prepare them to somehow have a decent death. Interventions
not only concerning the physical aspect are needed but spiritual as well. It is
deemed vital to spiritually prepare a dying client in order for him or her to
have inner tranquillity before passing away. That he or she is now going to
experience a life free of pain and illness. That way, the client will be at
peace.
There is no force on earth more powerful than the will to live. Reading this blogpost breaks my heart. It's just so sad that some people lost the will to live.
ReplyDeleteNice Blog pinkbutterfly! :D
ReplyDeleteSeeing DNR orders are very confusing. I mean, how can someone simply ignore the calling to help and save someone's life? But as nurses, we must know when to stand for our rights without trampling our patients'.
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ReplyDeleteDNR is something we always find it hard to decide. As nurses, it is our responsibility to prepare and help the family members understand in cases where decision making is needed.
ReplyDeleteAs nurses, it is really a dilemma on our part on how we are going to deal with patients who have DNR. Its heartbreaking not only for us nurses seeing patients with dnr without doing anything but also to the family seeing their loved one knowing that the pt dont want to save his life anymore. But we also must act as patient's advocate on his decisions on whether to save his life or let death take its natural way. And as healthcare provider, our care doesnt only end on the patients safety and needs but also we must also give support to the family on their grief.
ReplyDeleteWhile the nature of the work of nurses and other medical personnel is to save and prolong the life of their patients, we cannot deny the distressing truth that there are those patients whose hope are frail. Though not a nurse/nursing student, I can somehow feel and understand the weight of the quandary. Despite the fact that it is legal, the ethical views and perceptions on the matter of DNR vary from person to person and may be influenced by one’s own personal beliefs, culture, and environment.
ReplyDeleteMoral maturity takes a good stand in the debate of Do-Not- Resuscitate (DNR ) notion. In this connection, I believed that a good clinical practice cannot be separated from a professional and ethical behavior. Moreover, the debate on DNR would suggest that when an individual is incapacitated and unable to make healthcare decisions on his or her behalf would likely to suffer from ethical and legal dilemma (Bratcher, R. , Farrell, J.J., Stevens, K.A. and Vanderground, K.W. (n.a.). In this sense, nurses for example are the front liners of clinical situations in which lack of DNR orders creates ethical dilemmas requiring moral courage to advocate for the patient and family (Dr. Lachman, V. (2010). Thus, inevitable dilemma like this should be taken with precaution and prudence considering a holistic view on what stand do the medical professionals uphold in handing over a decision especially on the DNR notion. In supplementary, the study of Rurik Lofmark (2001) on the DNR: Ethical Aspect on Decision Making and Communication among physician, nurses, patients and relatives showed that professionals on the medical field have uncertainties on the rules and ethics of DNR orders creating a discrepancies between the guidelines and attitudes regarding DNR orders as well as between attitudes and behaviors. Hence, in this manner a medical professional should be knowledgeable about the promulgated provisions of the Do-Not- Resuscitate (DNR ) orders.
ReplyDeleteFrom what I've read, dealing with DNR orders is very confusing and difficult. The nurse's personal beliefs about life and death may be in conflict with the subject at hand. There should really be a lot of caution when dealing with this matter as it involves a lot of aspects
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