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 am a DNR/DNI, have no apparent health issues, and my colleagues I worked with knew this. However, it's like my work wife Eleanor asked, "But if you code on us you still want life saving measures, right?"
Of course I told her I did. The DNR/DNI has specific guidelines that state if my status is one where I cannot make my own decisions, and I have a terminal diagnosis, I want only comfort measures.
My medical nurse wife Belinda is well aware that when I have no quality of life, then she is to pull the plug.
I think you should definitely continue to advocate for this. Because above all else, I think ANYONE regardless of their age or health issue should be able to chose to be a DNR. Even myself as a healthy-ish person in their late 30s is a DNR due to personal choice.
Thanks!! Same here. My belief is that God puts "the wind" aka the "breath of life" into my lungs, and God has the ultimate choice of when the privilege of life has ended. Every breath we take is, and should be, from God, imho.
And also, BLS is basically just an open invitation to massive medical bills for what will probably only be a few days of added heart and lung function, which also just isn't worth it to me.
Well, imho you are really going to have some issues with this aspect.
Maybe you can do like a little umm anonymous post on craigslist in search of people whose doctors signed their DNROs out of a sheer respect for a patients right to make health care choices. You could at least find a health care surrogate and maybe at least keep in touch via email or something, to make a clear and saved trail of what your choices are. This way, if you don't get a DNRO signed, at the very least you can have a health care surrogate that can advocate for you. You would want a HIPAA authorization allowing your coworkers to call them and discuss your issues and what your needs are, of course. Hell, I will do THAT. I mean, geez if I know what you want, I can easily say "Yeah do NOT resuscitate that person!"
Additionally, this physician who signs the DNRO would, in many cases, have to be your personal physician.
So if all this stuff is out, you are kinda stuck with having a surrogate/proxy and pray that people see your little shirt button, see your surrogate paper, and call the surrogate.
I mean, Im really trying to find a way to help you get your personal choices known and respected, in any way that is legally possible, so these could all really work, even without an official DNRO. The big dnro for someone whose doctor won't sign one, is really going to be via the surrogate (because your opinion matters less somehow than your surrogate's retelling OF your opinions, at least in all these places where they are somewhat restrictive about issuing DNROs).
Ooh FYI.. Arkansas has penalties for all sorts of misdeeds with DNROs. From pretending it isn't there, to making a fraudulent one, .. it all ranges in charges from a misdemeanor to a felony. Kinda nice to finally see that.
Thanks. A couple of things in mind: I could switch my PCP from one organization to another and see if that helps. I may also have to pick a health care proxy who does not know me quite as well since the people who know me best are not willing to help with any aspects of a DNR/DNI order.
Ooh and OMG I just realized that if needed, you can also petition the courts to assign you a partial (limited) guardian ad litem to solely be your health care surrogate, to help you get the voice you need to confirm to those caregivers what your DNR/ advanced directive wishes happen to be.
No you should discuss funeral home arrangements with your family, husband, children, just whomever is actually planning your funeral.
OK. Wasn't sure if this would be good information or not. However, I am looking into making my own funeral arrangements for myself as I have no family interested in being involved. But, funerals are inevitable and there are actually several sources that suggest starting to plan for one's funeral in their 30's, so I'm not really acting premature.
My belief is that God puts "the wind" aka the "breath of life" into my lungs, and God has the ultimate choice of when the privilege of life has ended. Every breath we take is, and should be, from God, imho.
I support the right of individuals to make the decision on whether they want to be DNR. But reading your post about only God having the right to choose when the ”privilege of life” ends, how do you feel about antibiotics, pacemakers, neonatal resuscitation, surgeries, insulin, chemotherapy treatment or dialysis? What I’m really asking is how you feel about modern medicine in general?
If I want my DNR wishes to be respected, I'll need to have documentation. That's legitimate, however are there any tips on obtaining a DNR/DNI?
The forms that I have found that I could potentially use present some difficulties. First, they require "two witnesses." What happens when one does not have anyone to be a witness? I personally do not have anyone who is willing to be a witness to a DNR/DNI order. Also, is there any chance to have a DNR/DNI without a doctor's signature? I say this due to difficulties in finding a doctor willing to provide a signature.
Any help greatly appreciated. This way I can provide my coworkers the information they need in the event an unexpected emergency occurs at work.
To refuse to acknowledge a patient's right to refuse a treatment would mean these physicians found you incompetent to make your own medical decisions.
People have suggested there is something wrong with a young, relatively healthy person choosing to be DNR, although I don't find that to be the case. There are few Physicians I work with, all 'young' and healthy, who have POLSTS that they are DNR, comfort measures only, in the event that they have an out-of-hospital unwitnessed cardiac arrest. They are probably overly complicated, one has said he also bases it on presenting rhythm, another that he would continue care if no epi was used in the resuscitation (there is no evidence that epinephrine improves outcomes in unwitnessed out-of-hospital cardiac arrest). Being Physicians themselves probably helps when it comes to getting another Physician to sign off on the POLST, but more importantly they have reasoned support for their decision. For whatever reason the basis for your decision that you gave your Physician was seen as being so far off that it was evidence that you aren't capable of making medical decisions. Not saying they were right, just that you may want to further explore and research the justification you are providing.
Davey Do
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