DNR Does Not Mean Do Not Treat

Nurses and the meaning of DNR.

I recall a patient I had as a very new nurse who was designated as do not resuscitate, or “DNR.” The patient had suffered an intracranial bleed and because of his advanced age and untreatable cancer, his family had agreed that no CPR should be used. I remember the nursing supervisor asking me why the patient didn’t have a footboard and foam heel protectors on (that’s what we did back then); my answer was that he was a DNR patient. She basically handed me my head and said that his DNR status had nothing to do with good nursing care.

I never forgot that incident, and when I spoke with the authors of a mixed methods study with direct care nurses on three different units that found that “varying interpretations of DNR orders among nurses were common,” I immediately said yes. Their article is the original research article in AJN‘s January issue, “Nursing Perspectives on Caring for Patients with Do-Not-Resuscitate Orders.”

Families and providers may understand DNR differently.

And it’s not just nurses who may have different ideas and think differently about what should or shouldn’t be done for these patients who hover between life and death—other health care providers and families need to be clear on what […]

Every Frontline has a Backline: What Nursing Can Learn from Rugby

Photo credit: KJ Feury

Have you ever had a day at work that could only be fixed by an ice cream from your favorite creamery or by a hug from your best friend? Every shift during the height of the COVID-19 pandemic felt like this.

Unfortunately, because I work as an RN in a pediatric ICU at a large hospital in northern New Jersey, social restrictions that coincide with COVID-19 forestalled my usual comfort measures. After the start of the COVID-19 pandemic and during my reassignment in the COVID-19 ICU, I could no longer truly “leave” work. Work came home and walked with me throughout my day.

Dozens of IV pumps lining hallways, countless boxes of gowns, gloves, masks, and rubber shoes scattering the unit; ventilator alarms sounding; coworkers with surgical caps and masks, only identifiable by their eyes. The once medical–surgical unit transformed into a critical care unit equipped to care for COVID-19 patients.

After donning and doffing personal protective equipment (PPE), giving medication, adjusting ventilators, and updating families, you leave your 12+ hour shift wondering if you did your best. In the chaos of an unfamiliar unit, caring for patients with an unfamiliar virus, did I do everything to create the best outcome for my […]

The Essence of Nursing Care: A Powerful Tribute for Nurses Week

“Frontline nurses, as the health professionals who spend the most time with patients and their families, are central to ensuring that the patient experience is a positive and dignified one.”

Susan Hassmiller

This sentence from “The Essence of Nursing Care,” a guest editorial in the May issue of AJN, isn’t just rhetoric. It’s based on a recent and unforgettable personal experience of the power nurses have to recognize and sometimes ease a family member’s suffering at the very worst of times.

In this moving editorial, Susan Hassmiller, the senior advisor for nursing at the Robert Wood Johnson Foundation, writes about the nurses who helped her in the terrible days following her husband Bob’s tragic bicycle accident last fall. Writes Hassmiller:

“My life changed forever on Sunday, September 25, 2016, at 11:09 am. . . .That’s when I learned that Bob, my best friend and husband of 37 years, lay paralyzed in the trauma unit of a nearby hospital . . . .During those 10 brutal days, I learned anew the crucial role that nurses play in caregiving and compassion. Three nurses stood out in particular.”

I won’t attempt to summarize the rest of this guest editorial. It’s as eloquent a tribute as nurses are likely to get this year on Nurses Week. The article […]

Their Story: Each Patient is Someone’s Family Member

By Amy S. Jacobs, BSN, RN, CCRN. The author works as a critical care nurse in Tampa, Florida.

hospital corridorWhy does it usually take a personal experience of having a family member become a patient to make us see our patients in a new light—to see them as someone’s grandmother, father, sister, or spouse and not just a room number?

I’ve been a nurse in critical care for the past 10 years. Three of those years were spent as a travel nurse working short-term contracts in intensive care units across the country. And most of my ICU experience has been in trauma units.

I’ve watched a family come to grips with the fact their son is now brain-dead after a car accident.

I’ve comforted the husband and children of a patient who suddenly developed an infection and died after an apparently successful two-year treatment for cancer.

I’ve witnessed a daughter realize her dad is never going to be the same after a stroke takes away his mobility and speech.

I’ve seen a patient realize that, while he’s lucky to be alive after his motorcycle accident, he’s going to have to learn to navigate a new world without one of his legs.

As nurses we see these situations. We have sympathy for our patients and their families. We try to keep in mind the emotional support our patients need while also taking care of their physical […]

2016-11-21T13:00:57-05:00September 20th, 2016|Nursing, patient experience|3 Comments

Final Connection: An ICU Nurse Revises Her Feelings About Cell Phones

Illustration by Denny Bond. All rights reserved. Illustration by Denny Bond. All rights reserved.

Many of us have a love-hate relationship to smartphones, and each person (and generation) draws the line in the sand between invasiveness and usefulness in a different place. Cynthia Stock, the critical care nurse who wrote the Reflections essay in the November issue of AJN, “Final Connection,” starts her brief and moving story with honesty about such matters:

On Monday, if you had asked me how I feel about cell phones, I would have come up with this: I hate to listen to the drone of conversation coming from the person next to me on the treadmill at the gym. I don’t care about trouble with the HOA. I don’t care about a son who can’t decide on a career as a director or an actor. I work out to smooth the kinks in my soul from a job that requires me to navigate a relationship with life and death.

Today, ask me how I feel about cell phones. . . .

A good essay or story often centers around a reversal of some sort. What the protagonist believed may not be so true after all, or may be more complicated than first thought. As you can probably guess, in the […]

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