DNR means Do Not Treat

Malt123 · Jan 11, 2005

Thats what an advanced directive is for.....
DNR = Do not resuscitate.........Its only existence is to prevent CPR, Tubes,etc. Treating infections and so forth is up to your living will. Some people feel the same as you, but many feel the opposite. I cant count the times ive talked to a patient in regards to a DNR and their first question is "does that mean no more treatments?" Or patients being scared to become a DNR due to a lack of treatment.

some LTC facilities have a form that is signed by the resident and/or POA and gives directives as far as IV's, ABT, hospitalization this should be implemented in all facilities. I agree DNR does not mean you don't treat, what you don't do is attempt to bring someone back once their heart has stopped period........

purplemania, BSN, RN · Jan 11, 2005

my beef is not that there are a variety of DNR's status labels (with drugs, without compressions, etc), but that it is difficult to communicate the EXACT wishes to all pertinent personnel. I have received report from a nurse that the patient had DNR orders with certain exceptions. When I looked at the document I learned the nurse had told me the wrong thing. Luckily, it was never tested.

How do you guys handle commincation? We put a certain color on the patient's armband, but that still does not outline the full wishes of the patient/family. You still have to read the chart. What do you do?

NorthER,RN · Jan 11, 2005

I really appreciate this thread. I too work with people in critical care (ICU, CCU, ER) that think that DNR means Do Nothing. I believe that according to the patient's wishes that it actually means that my job is to be exta vigilent in ensuring that the "small things" are attending to very quickly and trends are caught before resuscitation is necessary. Yes, some patients do believe that asking for DNR status means that they will be left alone in a room with No Care - the patients and their families need to be reassured that this is not the case, although as I said earlier some nurses really don't want to do anything at all as if the patient were dead already. Well, in terms of ensuring that we know the actual status of the terms of the DNR we read the chart. The DNR is the first page on the chart. Kinda hard to miss. I know that things are different in between our countries (I'm in Canada) however my last hospital had a 4 page form for the patient or the POA to complete. Now working in ER unless the DNR paper work comes in with the patient from home we start everything. My mom (a nurse) always said that she was going to get the DNR tattooed on her chest and she'd sign it every day - guess I totally agree with that - just have to find the tattoo artist to help do it.

bobnurse · Jan 12, 2005

Its definately a subject that isnt discussed in nursing school in enough detail. Its all about the lack of education, not just nurses by the way.

bobnurse · Jan 18, 2005

anyone else?

RN30years · Jan 18, 2005

I have always thought it stood for [/u][/b]do not resuscitate. treat other symptoms pain infection fluid needs but do not resuscitate!

RN30years · Jan 18, 2005

I have always thought it stood for do not resuscitate. treat pain, infection,

maintain nutritional and fluid needs but Do Not Resuscitate

RainEdayWoman · Jan 18, 2005

I am not a nurse yet will start school this fall but just to give an outside opinion as a patient. To me DNR means that all measures to treat me will be done expect to resesitate me in the event I were to stop breathing and my heart stop. In other words I would not be put on life support or CPR to keep me alive. I think alot less people would be willing for DNR is they thaught that all forms of obvious treatments would be held back from them.

To be honest reading this thread has not only discouraged me alittle from the field being that there is so much leeway being given to a very important issue (there should be a firm and clear definition and standard of treatment) and has also put a slight fear in me as a patient. When a patient chooses to be a DNR they should have a clear definition of what that means. A patient should not have to worry because of their DNR status that one hospital may give up on them before they come through the door and another that will do all necessary means to treat them except in the event their heart stops.

Anyway this is just an outside opinion from a soon to be nursing student.

Antikigirl, ASN, RN · Jan 18, 2005

People make this more complicated than it should be much of the time. A DNR is as simple as Do not Recusitate if PULSELESS and APNEC! That is it!

Now on some forms you have additional implemenations to be considered that have been defined for you...this isn't a DNR...it is more of an advanced directive at this point! DNR is just that...one order!!!!!

Now, in my facility...unless they are on hospice or have a physicians order not to transport to ED, then I have to send them into the ED if they have a injury/acute condition/medical emergency...that is pretty cut and dry. Yes, that does lead to many folks not wanting to go to the ED getting patched up and sent back...but that is not my place to say either way! I have to go by the laws of the land so to speak, and my job is to get emergency help for a patient if they show signs and symptoms of emergency medical need period if I don't have an offical order to the contrary IE a EXACT order stating not to transport to the ED from a physician!

NOW, it is then up to the paramedics...whom I transfered care to...to make choices dependant on the parameters written below that one DNR order. Believe me guys, they know these things better than we do most cases..since they deal with them all the time! They know what they can and can't do according to their protocols! They stablize to the extent the protocols and laws allow and hand care over to the ED...then the cycle begins again! Then it is up to the MD... We nurses or paramedics are just stable transport to an MD so they can make medical choices for that patient, it is not up for us to debate...we don't have the ability given to us to order..they do!

For patients I see that wish to NOT go in, I talk with their PCP and try to arrange for hospice or family discussion about a do not transport order. And I also explain to family that if their loved one has a pulse and are breathing I have to treat (within guidelines expressed by patient via verbal or written order)..that I respect their situation, but by not treating a patient that has a pulse and breathing is considered neglect, malpractice, and in some cases murder! By informing family and patient..I am being a very good advocate BEFORE the probelm presents...because during the probelm isn't the time to get heavy into patient advocacy because time is of essence!

Also important to remember...a POA or a Spouse has the rights to say "treat!" if the patient can not speak or choose for themselves....but do not have the right to say "don't treat". That is for the protection of the patient who's family members may have their own interests in mind (ie conflict of interest). Remember this! A MD is the only one with the power to say DO NOT..it is a MD order to not treat!

bobnurse · Feb 11, 2005

anyone else?