We all know that DNR stands for Do Not Resuscitate, but the move in my children's hospital is to try to switch our terms from DNR to AND, which means Allowing Natural Death. The verbiage is very important because when parents here the words "Do Not" they automatically think that they are not doing something that they should be. Not doing everything they can.
Instead, our Pediatric Palliative Care team wants to change the culture and thinking of both the staff and the families. Allowing natural death means changing the goals of our treatment from cure to comfort. It means that we are doing everything we can to make their child as pain and symptom free as possible.
We have an excellent palliative care MD and the nurses in my PICU always try to get her involved when we are discussing end of life issues with family. She is thoughtful and considerate but honest and informative. Unfortunately, her bedside manner is not shared by all our MD's and we still continue to have situations where parents end up scared, offended, and distraught due to the less-than-sensitive discussions about end of life, and I'm afraid that some of our patients end up suffering more because of the way this is presented.
How are end of life discussions handled on your floors? What language to you use to explain the options to the families? Are their certain doctors who are called in to help with these discussions? What sort of education exists for nurses/physicians regarding palliative care?