Name change from DNR to AND

Nurses General Nursing

Published

i just read an article in a nursing journal that said the acronym dnr may be changing to and...(allow natural death). what are your feelings on this. i am thinking it will take a long time to get used to this !

praiser :heartbeat

Reno1978, BSN, RN

1,133 Posts

Specializes in SRNA.

I've heard people referring to this already...

To-may-to, to-mah-to.

My first impression is that AND - Allow Natural Death, is a much more accurate means of expressing the intent of what is or is not being done at the end of one's life. In my opinion, DNR - Do Not Resuscitate can convey the impression that health care personnel are actively withholding care to someone at the end of life and may make some hesitant to consent to it.

rn-n- 2005

46 Posts

Specializes in Hem/Onc, ER.

I read the same article also. I personally like AND better thatn DNR because it conveys a more positive message. I talked to some of my fellow RN's and we all liked it better and I'm trying to find out how to go about getting it more in the language of our hospital system. :nuke:

I also think it sounds better for the families. Instead of them thinking that we are NOT going to help their loved one, we are going to help them but also allow life to run to the inevitable end for all of us. I hope the way I wrote that makes sense. I'm not great at expressing myself verbally. :rolleyes:

rn-n-2005

Kabin

897 Posts

We use Allow Natural Death without an acronym.

leslie :-D

11,191 Posts

In my opinion, DNR - Do Not Resuscitate can convey the impression that health care personnel are actively withholding care to someone at the end of life and may make some hesitant to consent to it.

I also think it sounds better for the families. Instead of them thinking that we are NOT going to help their loved one, we are going to help them but also allow life to run to the inevitable end for all of us.

rn-n-2005

totally agree w/above.

let's face it.

there are many psychological components to dying.

DNR conceivably sounds like we are withholding care.

AND sounds much gentler, non-invasive and natural.

it makes 'letting go', much more bearable.

leslie

jjdennis1279

15 Posts

Does anyone have an online link to the above referenced article or other means of identifying it so that I can research it?

birdgardner

333 Posts

One problem is that other than homicide and accident, death is natural.

If the patient is in worsening respiratory distress, the natural progression is death.

If the patient has a UTI and goes septic, the natural progression is death.

The term DNR specifies drawing the line at resuscitation; AND does not specify at all.

Yes, it sounds better, gentler - but it will need to go along with a very specifically filled out checklist and much discussion, which may bring the patients and families back to the same place as before.

Specializes in CT ICU, OR, Orthopedic.

we use "code I,II, or III". III is DNR, I Is a "full code", II is no CPR or defib... Meds can be used though...

allnurses Guide

XB9S, BSN, MSN, EdD, RN, APN

1 Article; 3,017 Posts

Specializes in Advanced Practice, surgery.
Does anyone have an online link to the above referenced article or other means of identifying it so that I can research it?

take a look at this

http://www.dcmsonline.org/jax-medicine/2008journals/ethics/DNRorders.pdf

Katnip, RN

2,904 Posts

I prefer Allow Natural Death (AND). Not because I like it better than DNR but because patients and families see it as far more benign. As others said, that "Do Not" in many minds means do not help their loved one.

I think once families have that in mind they will be able to look at that checklist of what we will and will not do, and agree that allowing them to die naturally rather than performing CPR/ACLS much more easily.

It will take time for this change in perception to sink into everyone's mind, but once it does I think we'll be seeing a lot fewer elderly folks spending their last days hooked up to vents.

elkpark

14,633 Posts

One problem is that other than homicide and accident, death is natural.

If the patient is in worsening respiratory distress, the natural progression is death.

If the patient has a UTI and goes septic, the natural progression is death.

The term DNR specifies drawing the line at resuscitation; AND does not specify at all.

Yes, it sounds better, gentler - but it will need to go along with a very specifically filled out checklist and much discussion, which may bring the patients and families back to the same place as before.

I agree -- anything phrased as "allow ..." always sounds nicer than anything phrased "do not;" but we've had many discussions here over time about all the healthcare people NOW who think "DNR" equals "do not treat." At least "do not resuscitate" is v. clear and specific -- do not resuscitate. "Allow natural death" could mean don't suction 'em, don't bother turning 'em, don't bother with the most basic, "mainstream" interventions -- because we're allowing a natural death ...

IMHO, there are far too many "polite euphemisms" in healthcare already -- we would all benefit from a healthy dose of plain, clear English.

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