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 that designation means for the level of care the patient will receive. Without everyone being at the same level of understanding about the meaning of DNR, misconceptions can cause communication problems and exacerbate tensions in an already difficult situation.
DNR does not mean the withdrawal of care.
I remember a family who didn’t speak much English, but through an interpreter said they “wanted everything done” for their mother, who was in her 90s, cognitively impaired, and had advanced heart disease, which caused frequent episodes of ventricular fibrillation. This meant repeated interventions with CPR and repeated defibrillation—so often that we kept the code cart beside her bed. We finally learned that the family thought that if they said not to do everything, that meant we would not do anything, that their beloved mother would just be left to die.
You can watch a video abstract by one of the co-authors, but the takeaway message is clear:
“It’s critical to understand that DNR orders do not substitute for plans of care.”
Intervention can be those that prolong life, those that cause unnecessary suffering and comforting ones. Foam heal protectors can prevent skin break down in the heals that can be very painful and therefore are caring and comfort care that should be provided regardless of do not resuscitate status. I would had asked the same question. people in a coma should be cared for with the assumption that they can feel pain.