DNR Verbiage

[Katnip, RN]

Hi, all.

I just ran into a journal title that used the term "Allow Natural Death" in reference to a DNR.

I've experienced a lot of resistance to patients and particularly their families to declare a DNR. I was wondering if we started using the term Allow Natural Death instead of Do No Resuscitate if we would get more people on board with it at the end of life or when there is no more hope.

I know it's just a matter of the way they are worded, but words can have a powerful effect. To many families Do No Resuscitate sounds like we're just going to stand around doing nothing when we could try, where Allow Natural Death makes it sound like a more normal event and something that's acceptable, especially to families with an elderly family member.

Any thoughts?

Kat

[NeosynephRN]

Our form has two options...one where you can pick and choose what you do and do not want...and one that chooses to allow natural death... I believe it is worded as such

I choose to allow a natural death, to have invasive and life supporting treatments halted and to be made as comfortable as possible. Something like that anywhere...no where on our form does it say the actual words do not resussitate. I feel it is well accepted by families when presented in this manner.

[VivaLasViejas, ASN, RN]

I always explain to patients/families that "Do Not Resuscitate" does NOT mean "Do Not Treat". In other words, we will do everything we can to protect their dignity, treat the treatable, and keep them as clean and comfortable as possible up until the moment of death.

I think there's a lot of misinformation out there regarding DNR orders, even among healthcare professionals. I've had to fight paramedics and ER physicians time and time again to get frail elderly patients treated for pain and reversible conditions such as pneumonia, because I think even THEY frequently confuse DNR with "don't do anything". If a patient's comfort needs can't be met in their current setting, they need to be transferred to where they CAN be met, and if it's the hospital, so be it. I'm not interested in the argument that it's not cost-effective to treat the old and sick because they're nearing death anyway, or because their insurance isn't good enough. If they are in pain/distress and I can't manage it with the drugs and other treatments at my disposal, I'm calling in someone who can, and I don't care whether EMS or the ER likes it or not.

[Katnip, RN]

I always explain to patients/families that "Do Not Resuscitate" does NOT mean "Do Not Treat". In other words, we will do everything we can to protect their dignity, treat the treatable, and keep them as clean and comfortable as possible up until the moment of death.

I think there's a lot of misinformation out there regarding DNR orders, even among healthcare professionals. I've had to fight paramedics and ER physicians time and time again to get frail elderly patients treated for pain and reversible conditions such as pneumonia, because I think even THEY frequently confuse DNR with "don't do anything". If a patient's comfort needs can't be met in their current setting, they need to be transferred to where they CAN be met, and if it's the hospital, so be it. I'm not interested in the argument that it's not cost-effective to treat the old and sick because they're nearing death anyway, or because their insurance isn't good enough. If they are in pain/distress and I can't manage it with the drugs and other treatments at my disposal, I'm calling in someone who can, and I don't care whether EMS or the ER likes it or not.

I agree, there is a lot of misinformation. But I've seen time and time again where families believe we won't treat their loved one, or we'll out and out kill them, even after talking to them multiple times and multiple staff members, including clergy. I was just thinking if we changed what we call it, it would find more acceptance as a natural way to go.

[jerenemarie]

When I explain what DNR means, I'm honest about what it is and what a code is all about (potential broken ribs, punctured lungs, etc.) but I also make it clear it does not mean Do Not Treat. The Social Worker at my place of employment is the one who obtains the code status on admission and reviews their code status at quarterly care conferences. She does not explain it in a way that they understand...she will ask them if their heart should stop, would they want it "jump started". To me that really glosses it over for residents and families about what a code is all about. I strongly feel this is a nurses responsibility to explain DNR's to families and residents, not a social worker. Nothing against social workers, I just feel anything medical like this needs to be explained by a nurse! Thanks,

Jerenemarie