Your patient is termal. He has been close to you and even expressed to you his desire not to be resuscitated or maintained on machines or drugs. This morning, when you stick your head in the door to say hello, you find him unresponsive and not breathing. There is no DNR. What do you do? DO you put on the call light and call a Code, or do you make sure no one is watching and slip out of the room and tell no one? How do the options compete with each other?
Where I work there would be no question. No DNR, you call a code. It doesn't matter what the patient has told you. If he expressed a wish to be a DNR then this should have been dealt with before hand. A CNA cannot make that decision.
Where I work there would be no question. No DNR, you call a code. It doesn't matter what the patient has told you. If he expressed a wish to be a DNR then this should have been dealt with before hand. A CNA cannot make that decision.
That's what we were taught in nursing school, and that's the policy you will find in most facilities: unless the patient has a DNR order or other advance directive in place that says what we can and can't do if they tank, we are to treat them as a full code.
Doesn't matter if they're 8 or 80, healthy or terminal. Doesn't matter what they confided in you or what their family has told you. If there's no DNR order in place at the time that they code, we have to do everything we can to try bring them back. We can't risk assuming their wishes are otherwise based solely on their age and/or diagnosis or what a third party has said.
Of course, you can go down a whole ethical road about resuscitating an 80 year old patient with a terminal diagnosis and no DNR status. But that's another homework question.
Hence why most facilities will ask patients at admission about DNR/advance directives. And why patients should be educated on advance directives, as well as the fact that should they change their mind about DNR status or any other wishes, they need to tell their doctor or nurse immediately so it can be changed in their chart.
What you as the hypothetical CNA should have done is this: when you first learned this from the patient, you should made the patient's wishes known to the nurse. He/she could then could then have gone to the patient to discuss it with him and--after confirming if it was he really wanted--helped bring it about.
loriangel14, RN
6,933 Posts
Where I work there would be no question. No DNR, you call a code. It doesn't matter what the patient has told you. If he expressed a wish to be a DNR then this should have been dealt with before hand. A CNA cannot make that decision.