Well, what I've long suspected about the hospital in the town where I work is, in fact, true: DNR indeed does mean "Do Not Treat". The EMTs won't even transport someone to the ER if their advanced directive says "comfort measures only", even if they're in obvious DIScomfort. Why? Because some group of high-ranking muckety-mucks has decided that treating the sick is not a 'cost-effective' use of the hospital's services.:angryfire
I couldn't believe it when I read about this in the newspaper. Then I actually heard about it again from the paramedics I called today for a resident who was having severe back pain from an unknown cause. They were very sympathetic, but they told me the order had come down NOT to transport anyone to the ER unless they were, essentially, a full code and had one foot already in the grave. In other words, if a patient is elderly and/or has a DNR order, the hospital won't even 'treat 'em and street 'em' anymore. They won't even LOOK at them.
I am so angry right now I could spit nails. Naturally, I don't believe in using the ER as a primary care provider, but for crying out loud, when one of my residents is desperately ill or in pain and I don't know why---and their PCP isn't responsive to their needs---where else are we supposed to turn for help? And God help you if you're over 65 and on Medicaid.......you can't use the ER, but you also won't be able to find a PCP willing to take you anymore.
The thing that really burns me up is the fact that our Greatest Generation paid into the "system" literally for DECADES, and now when they need help, it's not there for them. In fact, the healthcare conglomerate here in our area treats them like parasites. Unfortunately, the organization is a monopoly, so it's the only game in town. And now it's turned every standard of decency I can think of on its ear: you're welcome to use the ER if you have private insurance and/or are young and 'productive', but if you're elderly, frail, and/or poor, the hell with you.
Yep, this really makes me look forward to old age..........when my body starts failing, I think I'll just walk way, way out into the wilderness and let nature do what it will, as our ancestors used to do when they sensed that their time was near. It beats the heck out of begging for some small share of mercy and being treated like a "useless eater", as one Adolf Hitler used to put it.:angryfire
Specializes in LTC, assisted living, med-surg, psych.
The patient in question may be 97, but until a couple of days ago she was no more in the active process of dying than you or me. She has been healthy as a horse her entire life---alert, pleasant, ambulatory, a mite forgetful but otherwise cognizant, no multisystem organ failure, only the occasional bout of angina for which she takes NTG. She just happens to have signed a POLST (Physician's Orders for Life Sustaining Treatment, a short form of the advanced directive) some years ago that states that she wants comfort measures only IF SHE IS DYING.
This is what chaps my hide.........so many people in healthcare seem to think that because a person is old, it's OK not to do anything for them because they're just going to die anyway. Well, so am I. So is everyone reading this post. The mortality rate is 100%, folks.......none of us are going to get out of this world alive.
It's what happens BEFORE we take that long dirt nap that I'm concerned about---and if that makes me "emotional" or "irrational", so be it. Better to be emotional than to be cold and unfeeling when it's human life that you're holding in your hands. As I believe I've illustrated already, it's the UNemotional types that rule health care nowadays, and health care is the worse for it.
The patient in question may be 97, but until a couple of days ago she was no more in the active process of dying than you or me. She has been healthy as a horse her entire life---alert, pleasant, ambulatory, a mite forgetful but otherwise cognizant, no multisystem organ failure, only the occasional bout of angina for which she takes NTG. She just happens to have signed a POLST (Physician's Orders for Life Sustaining Treatment, a short form of the advanced directive) some years ago that states that she wants comfort measures only IF SHE IS DYING.
Doesn't that still require a physician's order for her to be a "DNR"? Here, a living will/advance directive doesn't automatically make someone a DNR until the physician determines that it applies and writes the order as such.
The patient in question may be 97, but until a couple of days ago she was no more in the active process of dying than you or me. She has been healthy as a horse her entire life---alert, pleasant, ambulatory, a mite forgetful but otherwise cognizant, no multisystem organ failure, only the occasional bout of angina for which she takes NTG. She just happens to have signed a POLST (Physician's Orders for Life Sustaining Treatment, a short form of the advanced directive) some years ago that states that she wants comfort measures only IF SHE IS DYING.
Umm ok? -- You are involved with this patients care no? Obviously you are greatly concerned with the wellbeing of this patient which is a great thing. Given the contentions that you have made and the overall gist of your argument "No one cares about old people" "Heroic measures should be employed to help a decompensating patient that has requested comfort measures/DNR" "There are too many unemotional types in healthcare", should you not be as a nurse advocating for this patient and to this patient and informing her that she should RECONSIDER the comfort measures that THE PATIENT decided to have employed?
Keep in mind THE PATIENT is the one that requested the comfort measures/DNR, not the physician. You seem to be assigning blame to the physicians for following the will of a patient in a perfectly legitimate and pragmatic manner. If you feel as though the patient is so functional and healthy why dont you tell her to reconsider the comfort measures that she in fact decided to have???? That would make more sense than screaming about how insensitive physicians are for not taking a 97 year old ill woman who has requested comfort measures/DNR to the emergency room.
This is what chaps my hide.........so many people in healthcare seem to think that because a person is old, it's OK not to do anything for them because they're just going to die anyway. Well, so am I. So is everyone reading this post. The mortality rate is 100%, folks.......none of us are going to get out of this world alive.
Again, this argument makes no sense becuase IT IS THE PATIENT WHO DECIDED TO BE ON COMFORT MEASURES. The physician is merely following the will of the patient, if the patient does not want to be on comfort measures the physician will respect the patients wishes and change her to a code, its that simple, it has nothing to do with evil physicians not caring about old patients.
It's what happens BEFORE we take that long dirt nap that I'm concerned about---and if that makes me "emotional" or "irrational", so be it. Better to be emotional than to be cold and unfeeling when it's human life that you're holding in your hands. As I believe I've illustrated already, it's the UNemotional types that rule health care nowadays, and health care is the worse for it.
My advice is to never go on comfort measures and use every means possible continue your life, to whatever end...its a personal decision. In my opinion continuing to suffer in an aged body racked with disease and disability is more suffering than I would care to have and when I get to be 97 years old and chronically ill, by all means put me on comfort measures and give me the morphine and let me die in my sleep...don't put me on a code wheel me into the ER and try to save me in an attempt to ease suffering that cannot be eased - ridiculous in my opinion.....
The bottom line is you are trying to make this into an emotional argument when in fact it is not an emotional argument at all - it is about either you ARE or you ARE NOT on comfort measures and the decisions that result the given status. Really what do you want the evil physicians to do? IF someone is on comfort measures/DNR you expect them to exercise heroic means to save the patient when it makes no sense at all? And if they do the rational thing you condemn them as being unemotional and uncaring when in fact they are doing what any sane rational physician would do at EVERY HOSPITAL in UNITED STATES.
I think that health care personnel need a lot more education in what "DNR" means. My mother and father are both classified "DNR" but due to chronic conditions that have lasted years. I fully expect they will go to the emergency room for a broken hip, pneumonia, exacerbation of CHF, etc. and be treated the same as anyone. And they do. "DNR" is not a plan of care for either physicians or nurses. It doesn't mean a thing (or SHOULDN'T) until and unless the question is whether they need CPR and a code.
They were very sympathetic, but they told me the order had come down NOT to transport anyone to the ER unless they were, essentially, a full code and had one foot already in the grave. In other words, if a patient is elderly and/or has a DNR order, the hospital won't even 'treat 'em and street 'em' anymore. They won't even LOOK at them.
Are you saying that they won't pick up an elderly person? Say it ain't so! If so, wouldn't that be age discrimination? Who defines who is elderly? The 22 year old punk who thinks 30 is old?
If there ever was a time for a lawsuit now would be that time.
Heck, I'll move my grandma to your town, call an ambulance, have them refuse, and then sue them myself.
I think we are bound by more than just the legal system - we are bound by doing the right thing. And the right thing is to treat those who can be treated and comfort those who can be comforted.
DNR Comfort Care orders (DNRCC) require that only comfort care be administered before, during, or after the time a person’s heart or breathing stops. This type of order is generally regarded as proper for a patient with a terminal illness, short life expectancy, or with little chance of surviving CPR.
2) DNR Comfort Care-Arrest
DNR Comfort Care-Arrest orders (DNRCC-Arrest) permit the use of life-saving measures (such as powerful heart or blood pressure medications) before a person’s heart or breathing stops. However, only comfort care may be provided after a person’s heart or breathing stops.
I think that health care personnel need a lot more education in what "DNR" means. My mother and father are both classified "DNR" but due to chronic conditions that have lasted years. I fully expect they will go to the emergency room for a broken hip, pneumonia, exacerbation of CHF, etc. and be treated the same as anyone. And they do. "DNR" is not a plan of care for either physicians or nurses. It doesn't mean a thing (or SHOULDN'T) until and unless the question is whether they need CPR and a code.
You just stated in an earlier post " I am sure this will anger some people, but I refuse to be a DNR or to allow that for anyone I have a choice about."
Who exactly do you have a choice about? Obviously not your parents, because you stated that they are both DNRs, so then who? Your children? I hope not your pts, because that isn't your choice. And why would any of us be angry if you choose not to be a DNR?
As I believe I've illustrated already, it's the UNemotional types that rule health care nowadays, and health care is the worse for it.
It's sociopaths who rule health care and just about every major financial market and political seat in the country.
Just shoot me and get it over with quickly.
I guess that would solve a lot of headaches for these poor souls who might have to inconvenience and extend themselves a little more...just line the offenders up and shoot them.
Naturally, I don't believe in using the ER as a primary care provider, but for crying out loud, when one of my residents is desperately ill or in pain and I don't know why---and their PCP isn't responsive to their needs---where else are we supposed to turn for help? And God help you if you're over 65 and on Medicaid.......you can't use the ER, but you also won't be able to find a PCP willing to take you anymore. 
:lol2:
VivaLasViejas, ASN, RN
22 Articles; 9,996 Posts
The patient in question may be 97, but until a couple of days ago she was no more in the active process of dying than you or me. She has been healthy as a horse her entire life---alert, pleasant, ambulatory, a mite forgetful but otherwise cognizant, no multisystem organ failure, only the occasional bout of angina for which she takes NTG. She just happens to have signed a POLST (Physician's Orders for Life Sustaining Treatment, a short form of the advanced directive) some years ago that states that she wants comfort measures only IF SHE IS DYING.
This is what chaps my hide.........so many people in healthcare seem to think that because a person is old, it's OK not to do anything for them because they're just going to die anyway. Well, so am I. So is everyone reading this post. The mortality rate is 100%, folks.......none of us are going to get out of this world alive.
It's what happens BEFORE we take that long dirt nap that I'm concerned about---and if that makes me "emotional" or "irrational", so be it. Better to be emotional than to be cold and unfeeling when it's human life that you're holding in your hands. As I believe I've illustrated already, it's the UNemotional types that rule health care nowadays, and health care is the worse for it.