what is your openion about DNR ( donot resucitate)

Serenyd · Dec 9, 2005

:twocents: peg tubes - I think peg tubes are horrible. I have seen so many patients with peg tubes who are suffering. I understand it must be horrible when mom stops eating and you know if she doesn't get nourishment she will die - yet many of these patients are just lingering in a twilight zone existence caught between sleep and waking pain.

As for DNR, I think it's great for older people, but not so sure it is good for young people - if there is a chance I could be brought back and still have quality of life - I feel like I owe that much to my family. I have met people who have coded and been brought back and are fine. It's different if you're an older person who will not live very long even if resuscitated and will have poor quality of life because of health conditions. :twocents:

-Emma- · Dec 9, 2005

From what I know and have experienced, DNR is a doctor's order relating to a patient's "living will or advanced directive." (I can't remember which one I'm thinking of, so I will just call it Living Will.

Living will being a document (legal or just for reference depending on the state, local law, etc) stating what someone would want done if the he enters a terminal state (ex: end stage anything, vegetative) or becomes unable to make decisions for himself (ex: Alzheimer's, Dementia) and doesn't want to appoint a durable power of attorney (someone designated by the patient to make medical decisions for the patient.)

As far as how much power this document has, it depends on where the patient lives. In Pennsylvania (PA), the Living Will is just a document, the patient's family could override the Living Will and change decisions, I think that is because there is no law protecting practitioners from lawsuit; which the family can file for if the patient dies because they followed the patient's Living Will. I have since moved to Colorado (CO) where I'm told that the Living Will is legal and practitioners are protected from lawsuits that the family may file for after a patient dies due to practitioners following the Living Will. I've not been here long enough to see this play out.

It's all about communication with your next of kin. Make sure they know what your wishes are. The DNR order doesn't come into the picture until the patient is terminal with no chance of recovery from that end stage illness (unless the document states otherwise). So, if you have a Living Will at the age of 20, that's excellent. I've get to see someone come in with a document called "DNR."

I hope that I've gotten across what I wanted to say, in an understandable manner. :)

oldiebutgoodie, RN · Dec 12, 2005

A DNR is a personal decision.
Dad is DNR, he told me this, so that i wouldn't be "surprised" one day. I could see why. You could code, and yet be breought back in worse shape. Quality of life matters.
Same reason why, even though i'm still in my 20s, i'm a DNR.

Marie-LPN,

You're in your twenties?? Gee, your picture makes you look much older!! :rotfl:

Oldiebutgoodie

LCRN · Dec 12, 2005

A DNR is a personal decision.
Dad is DNR, he told me this, so that i wouldn't be "surprised" one day. I could see why. You could code, and yet be breought back in worse shape. Quality of life matters.
Same reason why, even though i'm still in my 20s, i'm a DNR.

Marie,

I completely respect your decision of making yourself a DNR- have you signed paperwork to this effect or have you just told your family members? The reason I ask this personal question is because if you were in a car accident and developed a pulmonary contusion and a pneumomediastinum ( common injuries in MVA's) and required short-term intubation and possibly vasopressor support because your body was in shock--> You would prefer not to have life sustaining treatment such as mechanical ventilation? or vasopressor support?

I work in a trauma hospital in critical care and am both happy and sad to see what the media has done with the Terri Shiavo case. I think it had made people more aware of their healthcare options but also more quickly in some cases to refuse treatment. What's your thought on it? In your state is it different? Just curious...

papawjohn · Dec 12, 2005

Hey Y'all

I agree with LCRN that the younger (I include my 60yr old self) people who've responded here should maybe think again about 'going gentle into that good night'.

There's lots of scenarios that could prove fatal in the short run but have excellent long-term outcomes. I have the same horror that I guess we all do at the fate of some of our patients--dying inch by inch on a vent. But if I had chest pain and was in the ER when I went into VTach--damned right I'd want to be shocked and intubated if necessary on my way to the cath lab!!!

I really have to think that someone in their 20's who's decided to not be resuscititated should think again.

Papaw John

Tanya-UKR · Dec 16, 2005

Here in Ukraine we do not have such a thing as DNR.But I had studied a lot about this subject recently because I needed it to my NCLEX-RN exam and I think that DNR is a personal decision.Sometimes relatives do not understand that they make the situation even worse for their beloved when they insist on code.Some people don't like to provide that "vegetative life" and they have a right to choose what to do.

Katnip, RN · Dec 16, 2005

The point of DNR is to allow a person to have some control over their lives and death. Same with advanced directives.

There's a fine line between saving a life and prolonging a death. Unfortunately, most people don't understand that. They think either medicine or God can pull off any miracle.

kersti · Dec 17, 2005

PHEW!-This is a really tough topic, with no "right" answer.

Like Papawjohn said- I think a big issue with DNR is that you have to look at it from all angles- is there an acute emergency that will enable you to live a fullfilling life afterwards? or are you terminally ill, suffering pain, and not living a "quality" life. And then, quality of life needs to be defined as well. What for one person is unlivable and awful could be perfectly acceptable for somebody else.

Also, in order to make an informed decision about DNR- you have to think about life and especially dying. Thinking about death and dying is not something that most people want to spend time on. It's like there are bad vibes associated with death- if you think/talk about it too much, you could get jinxed and it might happen to you???? This is what friends have told me is their take on the whole thing. Ironic, huh?

Education, and bringing discussions on not only death and dying, but about sickness as well into the mainstream would be the key.

papawjohn · Dec 19, 2005

Hey Y'all

The original post in this thread caught my attention because he was writing to us from Oman. The post from Ukraine was particularly interesting to me. I wonder about the cultural and religious aspects of Resuscitation and End of Life issues.

Does anyone have any thoughts on the way that our Pt's religious and cultural traditions affect their decisions? Or does anyone want to express what their own religious/cultural backgrounds mean for their own decisions.

I guess I was amazed at the 20-somethings who were prepared to "DNR" themselves. For someone in that age group--life seems so busy and incomplete, so much left to be done! Children to see grow up, marriages to spend lifetimes working out (or not), parents' lives to witness and learn from.

Is there a religious aspect to this? Are these youngsters anxious to get to heaven sooner rather than later? What gives here?

Any thoughts?

Scratching my old bald head

Papaw John

Tanya-UKR · Dec 20, 2005

I was interested to read nurses opinion about DNR.It is completely new issue for us and I think that here in Ukraine it is impossible to implement it.Because of our culture we are doing all to improve our patient's life span.Actually Nursing in my country completly differs from thouse in the USA.We do not have a chaine of commands and all critical questions we ask physycian and we receive orders directly from the physician.So they are responsible for care that pacients receive.And they are innterested to prolong patients life even if it is not a complete life.