Taking care of DNR patients. The point?

nurse2be13 · Apr 25, 2015

You can't be serious ðŸ˜‘.

MunoRN, RN · Apr 25, 2015

You're view is concerning. There are certainly a large number of patients who might very well be better off choosing less aggressive care beyond just being DNR, and in those situations ensuring that patients are receiving adequate information and support to make those decisions is often inadequate.

And while a patient choosing to be DNR should certainly prompt further discussion about goals of treatment beyond just what will happen in the event of cardiac or respiratory arrest, particularly in the context of a poor prognosis, DNR in itself in no way means that full treatment is not an appropriate choice for the patient. Just because a patient chooses to draw the line at resuscitation that doesn't mean we shouldn't put full in effort in avoiding the need for resuscitation. If there are reasons aggressive treatment is medically inappropriate, then that is a separate issue unrelated to DNR status.

CelticGoddess, BSN, RN · Apr 25, 2015

I am going to try to be gentle here. DNR does not mean do not treat. All patients, regardless of code status, deserve dignity and in some cases, treatment, even iif it is only pain management.

As far as your hospice patient with SOB. I pray you never experience the horror of being unable to breathe. I have asthma, and it's awful. I joke that I would rather be hit by a train than die from asthma exacerbation, except I am not joking. Being unable to breath is anxiety inducing, and scary as anything. To deny a patient the right to have treatment for SOB just because of code status is wrong. (BTW: I am a DNR, if a nurse didn't want to treat my asthma, I would be speaking to the manager)

You are treating these patients. Even if it is only pain meds, anti anxiety meds and a scope patch (or Robinul). No, you won't do CPR, but you are still treating the patient. Even a pt who is "allow natural death" deserves to be treated for pain/anxiety. And they deserve dignity. Nursing isn't always about saving lives. It's also about helping our patients into the next one.

~PedsRN~, BSN, RN · Apr 25, 2015

Being a DNR does not mean they want to live the rest of their lives uncomfortable and in pain - it means they want to avoid advanced life saving measures. It doesn't mean we stop caring for them. I find your viewpoint interesting... I have taken care of many children who were DNR status, and it was beyond a privilege to be involved in the end of their lives. To be a source of comfort for them.

Here.I.Stand, BSN, RN · Apr 25, 2015

DNR does not equal do not treat. Please examine your attitude.

Sun0408, ASN, RN · Apr 25, 2015

I can't answer right now and be professional. Sorry

RNKPCE · Apr 25, 2015

DNR doesn't mean the same as End of Life care. I know people who are active vibrant people but if their heart stops they don't want CPR. Infections will be treated and even some interventional treatments such as stents etc. Well I agree that telemetry may not be appropriate for End of Life Care, often hospitalization is necessary to ease suffering whether pain or SOB. Sometimes the most rewarding thing you can do as a nurse is helping a patient and their family during the last few days of their life.

I really hope this is a troll posting.

KelRN215, BSN, RN · Apr 25, 2015

I work on a very busy Tele floor and can have up to 5-6 patients a night. What kills me...is when I have a patient that is DNR. Seriously? Like what is the point?

The point is to treat their symptoms so they can comfortably return to hospice care and live out the rest of their lives not in agony.

So far, the DNR's are usually on their last leg, disease processed has moved to the final stages, yet you come to the ER with SOB, and admitted to my busy floor, and I have to now treat you as if I would treat one of my patients whose a full code - but, if you suddenly become pulseless, I cannot do anything anyway...grrrrrrrrr. How time consuming - why? I had a patient admitted from HOSPICE onto my floor for SOB - seriously?

Would you want to die gasping for breath? Air hunger can be treated and patients can be kept comfortable until the end. If the hospice cannot manage their symptoms at home, admission to the hospital is appropriate to get the symptoms under control.

Please help me understand you all. I am a new graduate nurse - 3 months - and when I get a DNR patient, I instantly get turned off. Sometimes these are the most time consuming patients with overbearing family members and in my mind I am like, the hospital is for saving lives if something lethal happens, I am not doing anything anyway. sigh.

The hospital is not exclusively for saving lives. You have a lot to learn. Nursing care doesn't stop when the prognosis becomes terminal. How unfortunate that dying patients and their families would have to be cared for by a nurse who considers them to be a burden.

MPKH, BSN, RN · Apr 25, 2015

I work on a medicine unit with designated beds for the DNR patients , some who end up dying on the unit. The point of DNR patients coming to the hospital is to receive treatments, just like any other patients who come to the hospital.

DNR is not do not treat. The plan of care for a DNR patient may differ from a non DNR patient, sure, but you're still giving treatments. Some people chose to be DNR even if they have years to live. And some people live with chronic, potentially debilitating diseases, living many years as a DNR. But you treat them nonetheless!

As well, where I am, most LTC patients that the hospital receive are DNR. Does this mean I don't give them the antibiotics for their UTI and let them suffer? No. Does this mean I stop their oxygen and let them gasp for breath? No!

DNR doesn't mean the patient is going to die imminently. It just means that when they go into cardiac arrest, you do not start those chest compressions and call a code.

Closer to death, you'd provide comfort measures. The workload might be heavier and the family can be demanding, but they're not much different than your acute patients who are going downhill.

The point from then on shifts to providing patients with comfort and reassurance to the family.

As a nurse, you're supposed to provide ethical, competent and compassionate care to ALL patients. This includes DNR patients. It's okay if you don't like working with dying patients, but I think you need to adjust your thinking on DNR patients.

sallyrnrrt, ADN, RN · Apr 25, 2015

using much restraint, here you have been given very good advice from prior post...if you do not grasp....you may not be suitable to be a nurse....i am that SERIOUS, i do have almost 43yr/experience to back that opinion

Dazglue, ADN, BSN, MSN, RN · Apr 25, 2015

Are you serious?