When sufferers have a do-not-resuscitate (DNR) order, it means they’ve chosen to not obtain cardiopulmonary resuscitation (CPR). However hospital nurses report vital variations in the best way DNR orders are perceived or acted on in scientific observe, experiences a survey examine within the January subject of the American Journal of Nursing (AJN). The journal is printed within the Lippincott portfolio by Wolters Kluwer.
“Whereas the definition of DNR may appear simple, its interpretation in scientific observe might be sophisticated,” in accordance with the brand new analysis, led by Patricia A. Kelly, DNP, APRN, AGN-BC, AOCN, of Texas Well being Presbyterian Hospital of Dallas, and Kathy A. Baker, PhD, APRN, ACNS-BC, FCNS, FAAN, of Harris Faculty of Nursing and Well being Sciences at Texas Christian College.
Differing perceptions of DNR orders could result in unintended penalties
Do-not-resuscitate orders have been part of healthcare for greater than 40 years. Printed pointers outline DNR by way of deciding to withhold CPR solely, nonetheless, research have proven healthcare suppliers and sufferers could also be confused concerning the that means and implications of DNR orders. An American Nurses Affiliation place assertion (PDF hyperlink) emphasizes that “sufferers with do-not-resuscitate orders should not be deserted, nor ought to these orders result in any diminishment in high quality of care.”
Based mostly on her experiences, scientific nurse Karen Hodges, BSN, RN, OCN questioned, “How do nurses perceive and act on DNR orders?” In response, Drs. Kelly, Baker, and colleagues carried out a survey and interviews with 35 hospital nurses concerned in caring for sufferers with DNR orders.
Analyzing the responses, the researchers recognized one main theme: “Various interpretations of DNR orders amongst nurses had been widespread, leading to unintended penalties.” Inside this overarching theme, there have been three key subthemes:
- Whereas the nurses offered clear definitions of DNR, they gave various interpretations of the specifics of care. For instance, whereas nurses agreed that DNR meant no CPR, some interpreted it as that means no different aggressive lifesaving measures.
- The nurses reported conditions the place healthcare workforce members disagreed about how DNR orders affected scientific care and obligations. One nurse identified that having a DNR does not imply the individual is a hospice affected person: “It does not imply that you just’re not going to do the whole lot that you’d for anyone else.”
- The nurses encountered household conflicts and confusion about DNR orders, notably when the affected person’s situation modified, and sufferers and relations typically disagreed about DNR standing.
These differing perceptions have the potential to have an effect on care in some ways, together with various responses when the affected person’s situation deteriorates, tensions amongst workforce members, and variations in position expectations. “Lack of readability and settlement about what DNR means in observe has a far-reaching affect,” Dr. Kelly and colleagues write. “It’s important for nurses to know that DNR orders don’t substitute for plans of care.”
Everybody – nurses, physicians, and households – must be on the identical web page in understanding the extent of care a affected person will obtain.”
Maureen Shawn Kennedy, MA, RN, FAAN, editor in chief, AJN
Dr. Kelly, Baker, and coauthors imagine that nurses play a key position in ensuring that sufferers, households, and healthcare suppliers have a transparent understanding of what DNR orders imply – and what they do not imply. “In each setting, nurses have alternatives to make clear such misinterpretations by means of observe, training, advocacy and coverage, and analysis,” the researchers conclude. “After 40 years as one of the widely known medical abbreviations, DNR ought to imply ‘don’t resuscitate,’ not an acronym which will diminish care.”
Kelly, P.A., et al. (2020) Unique Analysis: Nurses’ Views on Caring for Sufferers with Do-Not-Resuscitate Orders. American Journal of Nursing. doi.org/10.1097/01.NAJ.0000731652.86224.11.