DNR? Why not?

Specialties Geriatric

Published

i've worked ltc for my entire nursing career and i love my little ole men and women literally to death! what i want to know is that when they reach this point in their lives where they need us to basically help keep them functioning for as long as possible even if that means when they are in a vegitative state, i ask you, why are most of the oldtimers not on dnr status? on our unit our maximum censes is 60. right now we have 57. the average age is 73 and more than half are not dnr. why would you not want to be dnr? and what is the point? am i the only person with these feelings? i'm not sure if i should feel guilty about thinking this way about the people i take care of day in and day out.

we have a resident who is 79 y/o and has been there 3/4 of my nursing career in a vegatative state complete with gt, has had pneumonia god only knows how many times and in my opinion should have died along time ago. the staff have come to call him "uncle jimmy." uncle jimmy"? i asked one day to another staff nurse. and she said, "oh yes, uncle jimmy has paid for all of the neices and nephews college tuition. he is 100% service connected (veteran) and receives $1600.00 a month which his brother has control over his finances and receives his money. he has made it very clear that under no circumstances does he want his demented brother a dnr!" can you imagine keeping someone alive just for their money??? there should be a law against things like that. when it comes time for uncle jimmy to pass on, a code is supposed to be called and we are to vigorously work on him. oh dear god, let the man go.

. that only goes to show you that people will do anything for money. how cruel is that??? :o :o :o

Talino,

I respect my pt's family wishes...while I'm shaking my head, but I would never have my family member kept alive in his condition, full of bed sores, bouts of pneumonia one right after another in a vegatative state just to put my kids thru college? That isn't being kept alive for a purpose, that's being kept alive no matter what to suffer...His relatives need to be euthanized for making him suffer. I wouldn't keep my dog alive like that, I'd have the poor thing euthanized! You call that "wellbeing" for that resident? LOL...

tinkertoys,

My intention is not to make ANY decisions for my residents, just to take care of them the best that I know how. The Doctor is the one who "steers" the family members in the right direction. I know first hand it is not an easy decision to make b/c I had to make that decision for my brother in '96. He had an aneurysim (cerebral). And I chose to pull the plug the prognosis was very poor, cerebral blood flow was zero. He was only 49 years young. My living will was made out along time ago and my family knows exactly how I feel about being kept alive on all that mess. That's not living, it is merely existing. If I can't enjoy life and have to have someone feed me, someone to make me have a bowl movement, someone to wash me up after the BM and I can't scratch an itch anywhere, what's the point??? I just want to know what these people are thinking when they want their loved one kept alive??? Are they feeling guilty for some reason, money is surely another reason, What are they thinking??? Let them go...

peter73,

I hope my family doesn't try to override my living will...I better go see my attorney tomorrow and tell him to insert a clause..."Under no circumstances will my family try to override the decisions that I have made in this living will"...Thanks for the tip Pete!

aimeee,

If the families truely loved this person, they would make them a DNR and not let h/h suffer! just my 2 cents

Jackie8087RN,

In our facility, the only time the DNR is brought up to the families again, is when the resident is near death. The Doc will call the family and explain the status change and the family usually will agree to it at that time.

betts,

The resident is Not of sound mind, he HAS NO MIND, he is alzheimer's...He is not on my unit, therefore I won't get involved. Assisted suicide is a whole different ball game and I won't go there...

soulwaters,

I, too support families with their decision making, but like I said...while shaking my head. I therefore take care of the resident the best that I possibly can.

Jackie8087RN,

Alittle medication for relaxation is a good thing when you know you're in the dying process. I know that I would want it.

Thank you for the responses everyone, but keep them coming if you like...

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In UK law , no-one can give consent on behalf of another adult. Whilst relatives' views may be taken into account, and they should be included in reaching any decisions, their opinions are no more valid than those of the care team.

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Specializes in ER CCU MICU SICU LTC/SNF.
Originally posted by night owl

Talino,

I respect my pt's family wishes...while I'm shaking my head, but I would never have my family member kept alive in his condition, full of bed sores, bouts of pneumonia one right after another in a vegatative state just to put my kids thru college? That isn't being kept alive for a purpose, that's being kept alive no matter what to suffer...His relatives need to be euthanized for making him suffer. I wouldn't keep my dog alive like that, I'd have the poor thing euthanized! You call that "wellbeing" for that resident? LOL...

Bed sores, pneumonia, and the like?... the family does not cause that to the patient. The pt's well-being is the responsibility of the caregivers. Afterall his care was entrusted to the facility. You kept repeating the patient being kept alive. Did he ever go into a code and resuscitated? Does your facility or your state allow euthanasia? Like I said a DNR does not hasten a pt.'s demise.

You're entitled to your decisions so are these families who make decisions for theirs.

;)

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I don't know about other states but in Louisiana the major problem is lack of education about end of life issues and the DNR. Many people are familiar with advanced directives such as the famous "Living Will", and think this is all they will need. Instead of helping, the advanced directive issue has actually muddied the water for many of the elderly in my community.

To deal with this problem, we have included in our admission packet a form called Request for DNR. The new resident or his responsible party initials whether they desire resuscitation or no resuscitative measures. The form describes in detail what measures will be taken or not. Once initialed, the form is sent to the physician for his signature and then becomes part of the permanent record. We include this in the care plan and then it is discussed again quarterly to assure this is what the resident and/or family desires. It is, of course revocable at any time.

It has worked so well at our facility, (this was initiated approx a year ago), we now have about 80% of our residents with legal physician signed & documented DNR's. Of course, there still remain those who want everything done and we respect and support that decision. But at our facility, education of the resident and family has been the key.

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being a DNR is something that really no one wants to bring up-- i had to bring this up with my mother who is my father's caretaker very recently-- i had tried to go through this with her about three years ago-- she refused to talk about it-- she says dad should make the decision-- my dad is a victim of alzheimer's disease-- would have no quality of life should he have to be brought back-- i learned this lesson about 7 years ago-- didn't believe in dnr-- performed cpr on a patient for 45 minutes before the ambulance got there-- gave it my all-- she ended up dying nine hours later--yes if it is time for my father to go i want him to do it in a dignified way and making him suffer less is the best thing for him-- alzheimer's is its own hell on earth for its victims-- i had talked to my father about this a while back-- he said to me that he felt that he had lived his life-- he was 77 at the time-- now he is 80 and what is the quality of life he has now-- being incontinent of bowels and bladder and hoping that someone will give him something to eat-- pacing throughout the afternoon and night-- god i hope that a cure is found for alzheimers soon

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Specializes in Geriatrics, LTC.

I think some of the problem with not having a DNR status is how it is addressed t the patient. Some say to them "if your heart stops do you want us to try to restart it?" Well Yeah...DUH! But that isn't a good way to put it, somje feel that means they will be back to normal.....it needs to be put to them..."this is what you are possibly coming back to..." and then list the reasons. Some may realize broken rib and punctured lung, and no better quality of life then before...possibly even worse are not good reasons to stay alive.

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Well, we have a person on our unit who is cerebrally (?) dead according to repeated EEGs. He has miniscule fx. of his brainstem. His sister, who's his guardian,is adament about keeping him on the ventilator and as a full code. The attending physician is approaching our ethics committee. I'm glad.

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very very very very very very very very very very very very very very valid?????????

but as I am sleepwalking right now..........will not disgrace such a valid ?????????with an answer.......but say oh, oh oh so valid.......................

think it comes to acc eptance and denial+patient's belief system(no, please........no, no-------------please no religiousity thread here) just sayin......we all have our forms of acceptance...............of various things.........and I truly won't know form of this till it is knockin at my door...............

but please no jibes my direction.........as I am sleepwalking....................and going back to sleep now.........

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Does anyone have or know where there are statistics of the success rate of CPR in the elderly?

For a great advanced directive, see: http://www.agingwithdignity.org

I posted this on the death and dying thread, and I think it is worth posting again.

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I just reviewed ALL of the DNR posts. They are most excellent. I am writing a debate paper on this subject for my Past, Present and Future course and this will be so grand. Thanks to everyone who shared their opinion so that people like me can learn.

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l work in an ER surrounded by ltcf's......seems like 90% of the DNR's wind up in our ER....from acute care facilities capable of giving comfort care nursing!.....leaves me scratching my head???

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I.rae, I scratch my head intensly as I'm sending them to you!? I understand that it's the family's decision alot of the times, but my hat goes off to those who come to their senses at the very last minute when the Doc calls the family explaining prognosis is poor, condition is grave and there's not much more we can do. Making a decision to keep trying to revive them is futile.

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