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?
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.
Thanks for the feedback. Wonder what sort of justification they are looking for. They know I’m a nurse, so I clearly understand the implications of a DNR/DNI
Thanks for the feedback. Wonder what sort of justification they are looking for. They know I’m a nurse, so I clearly understand the implications of a DNR/DNI
Does your conversation with the Physician get any more specific than that? There's certainly more familiarity with the issues surrounding resuscitation being a nurse, but I'm not sure that alone is enough to convey that you are making an informed refusal of a treatment.
Does your conversation with the Physician get any more specific than that? There's certainly more familiarity with the issues surrounding resuscitation being a nurse, but I'm not sure that alone is enough to convey that you are making an informed refusal of a treatment.
One was reluctant to sign due to my “bleak outlook on life.” LOL. Didn’t realize that being happy-go-lucky was a requirement ?
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.
Ah I think I do understand the dilemma now.
Well, I think you could write up your wishes in a legal document, and even designate a guardian ad litem or a local pastor, to carry them out, if they would agree to do that.
If you don't have any written and legally binding plan, I think its possible that the county may end up cremating your body.
So you definitely would want to plan that, if nobody else is eager to do so for you.
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?
I have a lot more faith in preventative and comfort care, than I will likely ever have in actual rehabilitative/ restorative treatments.
Im not against antibiotics. I have used them a million times. By the age of 8, I had probably had 100 or more antibiotic prescriptions.
I have all my vaccines, including COVID.
I've had a lot more surgeries than the average joe, and usually surgery is VERY helpful. So I do have a tremendous amount of faith in surgery.
CPR is a whole other animal. I actually think the people who WANT to be full codes are the crazy ones. The chances of being discharged alive are very slim, so its generally going to just reissue life where life should simply not be continued.
I kinda think of CPR as a money maker, because the reality is, it so rarely (10.6% of the time on average) results in a live discharge, that I believe its just a fantastic way to hospitalize people in the last day or two of their lives, and even longer for those who go brain dead and are put on life support.
I mean.. what life is there left to support? Life ended. Let it be natural and far less intrusive.
Death is NOT optional. It's GOING to happen to us all.
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.
So, considering that you are SO enjoying making fun of the thread, lets examine your own logic. Your claim is that you are DNR who wants to also be full code, because you think you are going to have a higher "quality of life" if rescued from a state of being actually dead?
When your heart stops and you are in respiratory arrest, you ARE unable to make decisions for yourself.
You have ZERO life, your life has terminated, therefore there wouldnt be any concern for your life's quality, since it has officially ended.
So maybe I, captain obvious, should invite everyone else to start popping some corn, and lets see how YOU find any logic whatsoever in that statement.
Because, honestly, maybe I am not understanding why you have a DNR if you are actually a full code.
Perhaps a medical proxy for situations where you would prefer to not be kept on life support etc, would be more ideal for your situation..
You have an advance medical directive, but an advance directive isn't necessarily a DNR.
So pop some popcorn and read your statute, before you come back here making snide and sarcastic remarks about other peoples actual DNR status. Sheesh.
Kitiger, RN
1,834 Posts
Whoa. Impressive!