I couldn't help but respond here. I have made myself quite a nuisance with those above me (Nursing Mgt., MDs and case managers) on precisley this topic. My unit care for a lot of extremely elderly patients or those with multiple morbidities to complex for home care. I came on the other morning and got report on a 98 y.o. lady who was bleeding from the rectum overnight. Her diagnosis on admit orders and on the kardex, was anemia and dehydration, and she was a full code! Are you worried? I was. I did a chart review on her, because I just could not see myself and the other nurses performing a full code on a extremely sick, extremely fragile woman. There was nothing more to be gotten from the chart. She was transfered to us from another unit and I found her old chart, which did have her H & P. Turns out she had a massive CA mass iin her colon, the family had decided on comfort care, the patient was not told her diagnosis on request from her family (pt had some dementia), and still NO DNR! The MD did not take the time to fill one out. No signed DNR in the chart means full code no matter what anybody has charted! I tracked the MD down and got the appropriate paper work done, but can you see the amount of time and energy this took. Can you imagine the trauma to that old lady if in her last minutes of life a code was called on her.
Unfortunately the above example is very common. People are uncomfortable, especially MDs, to discuss end of life decisions. But to be the holistic, patient centered nurses we trained to be, we must discuss this. I have found that my patients almost always know exactly what they want done, or not done to them, and most I glad I care enough to ask.
Please make this a part of your practice!