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.
