Note: This might seem like a strange topic, but seeing as how that is nothing new coming from the source, I'll go ahead anyway.
As nurses, we are trained to do everything we can to save someone until it's no longer feasible or unless doing so would go against a patient's wishes, such as performing CPR for a patient with a a DNR/DNI.
However, theoretically, anyone of us could "code" at anytime--and this includes at work.
For those who are full codes, this wouldn't create any ethical issues. You would simply perform CPR on your coworker as you would anyone else.
However, for those who have DNR/DNIs, issues could come up if coworkers are unaware such orders exist. How do we ensure that these coworkers have their wishes respected should the need come up?
For example, I am legally a Full Code but am wanting to pursue a DNR/DNI. Based on my age and no apparent health issues, I have a feeling most of my coworkers would automatically assume I am a Full Code should circumstances arise, however.
What is the best way to inform my coworkers that under no circumstances should anyone provide CPR to me?
For the rest of you, how do you ensure your coworkers' wishes for CPR or no CPR are ensured? Have you ever experienced such an ethical dilemma at work?
I would possibly question someone's mental health if they go to such measures re a DNR. I would find it quite bizarre if a healthy person had such an obsession. Now, if it's a person who has the potential through illness etc, I can understand that. But, a working nurse feeling the need to address colleagues etc, I would say a mental health assessment might be called for.
Frankly, we are all already aware that a persons own doctor signs their DNR form, and also, that the only real qualifier for any patient to make their own choice, is to be alert and oriented, so honestly, its not up to you to try to also determine whether that person is healthy enough to make the determination to sign their own DNR form, with their doctor signing an approval.
But since you must know..
I had 8 years of sickness as a child from a birth defect. I also, prior to my current healthy and happy marriage, had 20 years of domestic violence, service related trauma, and rapes, ad nauseum.
Those are not my reasons for signing a DNR.
See, while I am a relatively healthy person, I am also cognizant of the chances being taken by receiving BLS. Chances are, I would die a day or two later, ANYWAYS. I would just have to additionally endure the pain of loosened and broken ribs, in addition to the pain of having my heart stop. I would also HATE the thought of being on life support. Ugh what is even the POINT? I wouldnt want to financially ruin my family's ability to have a proper funeral and pay my debt and final expenses, over something as STUPID and POINTLESS as life support. It costs a LOT of money. I think it runs at around $10,000 extra per day, above and beyond regular inpatient billing. While I do have VA health care, if I was to be put on life support elsewhere, and the VA didn't approve paying for the visit, I might not even get a damn funeral. Thats AFTER having to suffer for an extra two days in pain because some moron couldnt respect the laminated signed legal DNR form that me and my doctor signed together, that I intentionally hang daily from my ID lanyard.
When my heart stops beating, I am dead. Let me be dead. I actually question the sanity of anyone who doesnt understand that I am already effing dead. Haha I mean wow. Making me undead is just plain SICK.
Withholding/ Having to give BLS is also not FOR YOU.
While you, Curious, like to feel like a God by briefly restarting someones heart, many others do not like anyone BUT God doing His own good deeds.
BLS/ vs No BLS is just not about YOU.
Again, this is what separates the men from the boys.
This is also included in the PDF file you attached.
So, you will essentially use the word "may" to just negate the reasonable person standard, as long as it suits your need to feel heroic?
Even while saying that most people resuscitated do not actually have a positive outcome. You just do what YOU want, rather than what your patient clearly wants.
Wow.
PS if you werent so intent on trying to prove me wrong, you would know now that DNRs don't expire.
So why even bother questioning them at all. I mean, really. Wow.
To be clear, the reasonable person standard is much akin to informed consent, and respecting a persons autonomy, to wit: if a person has a signed DNR form, the reasonable person standard is that the person is indeed refusing care, which is their RIGHT and their informed decision.
Some people refuse chemo for cancer, because it is preferred to die naturally, than to die after suffering more for simply a longer period of time. Some refuse dental care, because they don't like needles or being poked at. Some refuse vaccines because they don't like needles.
You CANNOT force people to do stuff that might help them live longer, just because YOU THINK ITS A BETTER DECISION than the one they already made.
Period.
And if yall don't understand rhis, I hope to God some nurse educators and HCAs see this article, and educate yall on what THE RIGHT TO REFUSE actually means. There is a lot of information here. You can just "find in page" the term DNR and start there if you like. I genuinely believe that some of you are grossly misinformed about respecting patient rights. I truly hope this helps you understand this a lot better.
So,you will essentially use the word "may" to just negate the reasonable person standard, as long as it suits your need to feel heroic?
[...]
I'm not saying may, the state of Florida is. If the state felt strongly enough that it should be honored anywhere within the state, and not just in helathcare facilities the should have either included that wording, or established a portable DNR, similar to North Carolina's Medical Orders for Scope of Treatment (MOST) form, which must be honored anywhere within the state.
As for your "suits your need to feel heroic" comment, I'm at somewhat of a loss how you came to that conclusion as nothing in my post even vaguely suggests that. During my time as a paramedic, if the patient's wishes were known, and all of the family present were in agreement, I had no problem in honoring their wishes.
Frankly, we are all already aware that a persons own doctor signs their DNR form, and also, that the only real qualifier for any patient to make their own choice, is to be alert and oriented, so honestly, its not up to you to try to also determine whether that person is healthy enough to make the determination to sign their own DNR form, with their doctor signing an approval.
But since you must know..
I had 8 years of sickness as a child from a birth defect. I also, prior to my current healthy and happy marriage, had 20 years of domestic violence, service related trauma, and rapes, ad nauseum.
Those are not my reasons for signing a DNR.
See, while I am a relatively healthy person, I am also cognizant of the chances being taken by receiving BLS. Chances are, I would die a day or two later, ANYWAYS. I would just have to additionally endure the pain of loosened and broken ribs, in addition to the pain of having my heart stop. I would also HATE the thought of being on life support. Ugh what is even the POINT? I wouldnt want to financially ruin my family's ability to have a proper funeral and pay my debt and final expenses, over something as STUPID and POINTLESS as life support. It costs a LOT of money. I think it runs at around $10,000 extra per day, above and beyond regular inpatient billing. While I do have VA health care, if I was to be put on life support elsewhere, and the VA didn't approve paying for the visit, I might not even get a damn funeral. Thats AFTER having to suffer for an extra two days in pain because some moron couldnt respect the laminated signed legal DNR form that me and my doctor signed together, that I intentionally hang daily from my ID lanyard.
When my heart stops beating, I am dead. Let me be dead. I actually question the sanity of anyone who doesnt understand that I am already effing dead. Haha I mean wow. Making me undead is just plain SICK.
Withholding/ Having to give BLS is also not FOR YOU.
While you, Curious, like to feel like a God by briefly restarting someones heart, many others do not like anyone BUT God doing His own good deeds.
BLS/ vs No BLS is just not about YOU.
Again, this is what separates the men from the boys.
I agree with the resus methods, it's horrendous and barbaric. But I think life is precious and I am for appropriate abortions after careful consideration. However, knowing that people change their minds often even about something as important as this especially now you are at a happier period, how can you be so sure? For myself, I told my parents, no current documentation, if my eeg shows good brain activity and a high probability of being able to process information, do not pull the plug! Advances are being made at a rapid pace currently.
Also don't we automatically want to preserve life and how can anyone assess quickly if they see a potentially good outcome for CPR, follow a DNR? You're choking and you are blue and unresponsive when you are found. How can anyone know that if they managed to clear your airway and administer O2 that you won't make a full recovery?
I just don't know how you could be so sure and do a cost analysis re your life.
so honestly, its not up to you to try to also determine whether that person is healthy enough to make the determination to sign their own DNR form,
Before Oncology had their own ICU we sometimes transfered patients to the main hospital ICU. I would hear things like "they have cancer, Aren't they a no code?"( Often times they had AML and we just couldn't keep up with all the meds (IVs etc) . I would relate that even if they weren't a no code, that doesn't mean no care. Many patients returned to the floor, were discharged home and lived several more months and some outlived their disease.
I'm not saying may, the state of Florida is. If the state felt strongly enough that it should be honored anywhere within the state, and not just in helathcare facilities the should have either included that wording, or established a portable DNR, similar to North Carolina's Medical Orders for Scope of Treatment (MOST) form, which must be honored anywhere within the state.
As for your "suits your need to feel heroic" comment, I'm at somewhat of a loss how you came to that conclusion as nothing in my post even vaguely suggests that. During my time as a paramedic, if the patient's wishes were known, and all of the family present were in agreement, I had no problem in honoring their wishes.
Once again, you failed to read the full page. There is a portable DNR. You just choose to not be informed of this, despite all the educational materials being at your fingertips.
This is obviously a lost cause. I mean, short of a home bound or nursing home bound patient having someone throw a paper in your face, you don't *want* to encounter a DNR.
I mean, and why would a DNR patient even have an ambulance called in the first place? They clearly don't need or want a paramedic. But okay. Say someone called 911 for someone else, despite the patients family, "all agreeing" to it (which again, if they did agree, they obviously wouldnt call an ambulance, and also, its the patients decision, and a DNR tells you that much, which should be enough, considering that its legally enough!!) But yeah lets say someone called for a medic anyways.. WHOOPS!! No they didn't.
SilverBells, BSN
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