Is DNR (do not resuscitate) a good idea?

Altra, BSN, RN · Jun 11, 2008

There is no right or wrong answer to this question (homework?) ... it is entirely dependent on the values and belief system of the individual patient.

miko014 · Jun 11, 2008

I'm not sure what you mean. Do you mean is it a good idea to offerthe option of being a DNR? Heck yes!!!!! Otherwise, you would be coding every 90-year-old in the hospital! There are many people who would never make it through a code, so why put their bodies through all that, put the family through it, waste all the time and the money on it? It's one thing to be fairly young or healthy, but it's another to be 92 and dying. Why spend the little time you have left (at any age, whatever the condition might be) in the hospital on all these meds that make you sicker, missing out on everything you could have done?

If you mean should we make everyone with a terminal illness a DNR, no way. That's a personal decision. If auntie Mildred is 88 with COPD, pneumonia, and a PE, but she wants to be coded, code her. Do everythign you can to keep her alive if that is what she wants.

Bottom line, like many have said before, this should be the PT'S decision if at all possible. I hate it when someone is dying and suffering needlessly because we can't give them enough pain meds to make them comfortable without depressing their resps, all because the family can't let them go. What a terrible existence that would be. So the pt should be the one to decide, way before they get to the end. That's why we need to approach the subject, and/or press the docs to do the same. Some of them are great about it, and some of them...well, they don't like to bring it up.

CHATSDALE · Jun 11, 2008

this is not something that should be held in reserve for terminal or elderly patients

it starts with you, everyone of majority [18 most states] should make out a living will and put down your wishes and designate some one with backbone to see that your wishes are carried out

you never know when someone will come out of side street and leave you without enough brain to make a decision or to have a meanngful life..case in point that young man in the hulk hogan's son accident

and just as important you can put down 'EVERYTHING POSSIBLE BE DONE' at least this will make your wishes be done

telling your family, without anything in writing, frequently does not hold up in making a legal decision

sharkdiver · Jun 11, 2008

I second what Chatsdale said. This is something every adult should think of ahead of time and execute the proper written document (living will or advanced directive depending on your state of residence) clearly outlining your wishes. Depending on age and circumstqances, a POLST is an additional step that might be considered in those areas where it is available.

KaroSnowQueen, RN · Jun 11, 2008

I think discussing one's wishes in regards to end of life measures is a thing to be done AT ONCE!!

I cannot think of anything worse, watching someone get the "whole nine yards", intubation, CPR, vent, etc, who did NOT want it, but did not make his/her wishes known and the family can not get together and make the decision "We don't want to kill Grandma."

I agree physicians do a ****-poor job of making the point of DNR and explaining end of life extreme measures to people.

My family knows my wishes, my last surgery I had a witnessed Living Will drawn up and given to all my doctors and the hospital. I have told my husband and my kids that if they are given a prognosis of "no hope" and that I believe in my heart that is correct, I will let them go.

We had a "shirt-tail relative" (one that is so remotely related that they aren't really a relative anymore) whose husband had her coded nine times in eight months. She never left the hospital. The day she finally died, he was standing at the door yelling at the staff to get back in there and bring her back. I couldn't decide whether to be so angry with him for selfishly holding her here when she was too sick and miserable to know anything, or feel sorry for him for loving her too much to let her go. I finally decided that it was possible to have both emotions. But when he died a few years later, he made sure everyone knew he was a DNR -- and that kind of made me mad all over again!!!!

Kinda got OT there, but in the end, YES DNR is always a good choice for those who know there is no recovery, that prolonging existence is NOT the same as prolonging life.

allnurses Guide · Jun 11, 2008

Even my 13-year-old son was able to handle having this conversation. He died of AML in January of 2007. Just prior to TBI for SCT, the doctor mentioned a living will. Joseph wanted to know what that was, we talked about it, he thought about it and then calmly told us if there was no chance he would get well, to let him go. Months later, after four weeks on a ventilator for CMV pneumonitis, the day after his doctors gently suggested for the first time there was no hope, we made the decision to release him from his suffering. He passed within five minutes of the machines being turned off. It gives me peace to know we honored his wishes. It is unfortunate that more people cannot respect the desires of the dying. There IS such a thing as a good death. To me, DNR can be one part in allowing a good death to happen. His passing was peaceful, dignified and calm with all his nurses and his oncologist and critical care doctor at the bedside with his father and I, honoring his quiet transition rather than descending into frantic drug pushing, chest cracking chaos.

I am in favor of DNR in terminally ill patients if that is the patient's wish. Not everyone is able to accept one day they are going to die unfortunately.

frodo · Jun 11, 2008

I think the problem is that people can't accept that death is a stage of their lives, such as the beginning is birth, and the end is death. i coded an elderly man, and i can still feel the bones under my hands, doing compressions. we (medical field) need better education on the death process.

Blee O'Myacin, BSN, RN · Jun 11, 2008

Is it the best thing to do when you have terminally ill patients?

What do you think? I think you've gotten a fairly reasonable amount of responses here. Do you think it's a "good idea"? Or is it technology going above and beyond what's humane or natural? Do you think that every person should be treated to the full extent that technology has? Where do you draw the line? What do you tell your patients?

People die. Some before they should and no matter their code status, it's a tragedy.

So is this an ethics class assignment or what?

Blee

allnurses Guide · Jun 11, 2008

Even my 13-year-old son was able to handle having this conversation. He died of AML in January of 2007. Just prior to TBI for SCT, the doctor mentioned a living will. Joseph wanted to know what that was, we talked about it, he thought about it and then calmly told us if there was no chance he would get well, to let him go. Months later, after four weeks on a ventilator for CMV pneumonitis, the day after his doctors gently suggested for the first time there was no hope, we made the decision to release him from his suffering. He passed within five minutes of the machines being turned off. It gives me peace to know we honored his wishes. It is unfortunate that more people cannot respect the desires of the dying. There IS such a thing as a good death. To me, DNR can be one part in allowing a good death to happen. His passing was peaceful, dignified and calm with all his nurses and his oncologist and critical care doctor at the bedside with his father and I, honoring his quiet transition rather than descending into frantic drug pushing, chest cracking chaos.
I am in favor of DNR in terminally ill patients if that is the patient's wish. Not everyone is able to accept one day they are going to die unfortunately.

I am so sorry about your son and I just wanted to thank you for sharing your story. He was so very lucky to have a mum who was able to respect his wishes and act in his best interest. Thank you so much for sharing, it's accounts like yours that helps reminds those who are caring about the other side.

walk6miles · Jun 11, 2008

In my opinion, DNR can frequently back-fire on the patient. Many doctors and nurses interpret the DNR to mean "do not treat". So we receive a cachetic, bedsore ridden shell of a person from the nursing home; frequently they have been displaying sypmtoms of pneumonia or sepsis for several days. Treatment is often minimized or worse, withdrawn because they are 94 years old and "it's their time".

I would never advocate NOT treating someone however, treatment should be appropriate with the patient's wishes. Everyone has seen (at least once) a family over rule a mother's/dad's wishes. It is the most selfish kind of love when the son or daughter says to the doctor "I know my mother never wanted to be intubated but she's unconscious now and I want every thing done for her." Maintaining a balance between family members should never fall to the health care workers BUT frequently it does.

Knowing how much to do and when to call it ENOUGH and make the patient comfortable with the proverbial "family filled room" comes with experience. Frequently nurses are not willing to speak up and educate the family; it's a very hard thing to do. This sort of experience happens more and more frequently today simply because medicine has developed so many treatments that work to prolong life. It's a two-sided blade.

Just my humble opinion.

tencat · Jun 12, 2008

In my opinion, DNR can frequently back-fire on the patient. Many doctors and nurses interpret the DNR to mean "do not treat". So we receive a cachetic, bedsore ridden shell of a person from the nursing home; frequently they have been displaying sypmtoms of pneumonia or sepsis for several days. Treatment is often minimized or worse, withdrawn because they are 94 years old and "it's their time".
.

I think that experience might have more to do with the horrible understaffing conditions rampant in so many nursing homes than with one having a DNR.

miko014 · Jun 12, 2008

In my opinion, DNR can frequently back-fire on the patient. Many doctors and nurses interpret the DNR to mean "do not treat". So we receive a cachetic, bedsore ridden shell of a person from the nursing home; frequently they have been displaying sypmtoms of pneumonia or sepsis for several days. Treatment is often minimized or worse, withdrawn because they are 94 years old and "it's their time".
I would never advocate NOT treating someone however, treatment should be appropriate with the patient's wishes. Everyone has seen (at least once) a family over rule a mother's/dad's wishes. It is the most selfish kind of love when the son or daughter says to the doctor "I know my mother never wanted to be intubated but she's unconscious now and I want every thing done for her." Maintaining a balance between family members should never fall to the health care workers BUT frequently it does.
Knowing how much to do and when to call it ENOUGH and make the patient comfortable with the proverbial "family filled room" comes with experience. Frequently nurses are not willing to speak up and educate the family; it's a very hard thing to do. This sort of experience happens more and more frequently today simply because medicine has developed so many treatments that work to prolong life. It's a two-sided blade.
Just my humble opinion.

Interesting perspective. What's your answer? Do you think it should be just up to the docs? Everyone stays a full code until the docs say "okay, enough, we're done here, DNR". Should we code everybody no matter what? Don't take this the wrong way, I'm not trying to challenge you or argue with you. I've seen what you're talking about (not on our floor, thankfully - we specialize in DNRs), and it infuriates me. Youre a DNR? You've got pneumonia? Cool, have some antibiotics and go ahout your business. But you're right, a lot of the time it's "oh well, time for you to go!" Just wondering where that side of your mind goes. :specs: