Nurses as stated in the ICN ( 1997 ) have a unique
and primary responsibility for ensuring that individuals at the End of Life experience a peaceful death.
Nurses have a moral obligation to honor the DNR decision. If health care providers cannot agree with the
patient's desire to keep a DNR order the health care providers should be reassigned. Thus will not jeopardize the health care providers' professional licenses or conflict with their own
personal beliefs.
Policy and procedure of each institution will protect and guide practicing healthcare provider with the correct understanding of DNR concepts and its boundaries, it will create less confusion and stress to individuals and will
Recommendations
1. Family support should be highly emphasized to the nurses, giving
them trainings on how to deal with end of life issues.
2. A specialized, Family Care nurse should be assigned in the unit
to assist the family in crisis management as they go along with the grieving process. A person in authority should be always available to discuss with the families their treatment options, the legal
implications and their rights.
3. Appropriate ethics education should be offered by the institution
to its nurses to develop their reflective ethical practices.
4. Increasing the awareness of the staff for the DNR policy and
procedure.
5. Future studies should be done to explore other factors that may
affect the nurses perceptions and practices towards DNR patients and to further investigate what is the effect of these perceptions to their practices.
References
• RMH DNR policy and Procedure, 2007
• Morton, et al., Critical Care Nursing – A holistic Approach,8thEd. 2005
• Johnstone, M.J., Bioethics: A Nursing Perspective, 5thEd., Elseveir Australia: 2009.
• Miranda DR. Quality of life after cardiopulmonary resuscitation. Chest. 1994; 106 (2):524-9.
• http://www.deathreference.com/Da-Em/Do-Not-Resuscitate.html
• http://www.deathreference.com/Me-Nu/Natural-Death-Acts.html
• http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijh/vol7n1/dnr.xml
• Compliance with DNR policy in a tertiary care center in Saudi Arabia King Abdulaziz Medical City
(KAMCAlaa Gouda, Ahmad Al-Jabbaryand Lian Fong, 2009
• http://www.aacn.org/WD/PressRoom/Content/aboutcriticalcarenursing.pcms?pid=1&&menu=
• Nurses' attitudes toward do-not-resuscitate orders.Purvis RJ, Law E, Still JM, Belcher K, Kito N,
Dorman JB.Columbia Augusta Medical Center, Augusta, Ga., USA,
• Nurses' perspectives concerning do-not-resuscitate (DNR) orders.Hosaka T, Nagano H, Inomata C, Kobayashi I, Miyamoto T, Tamai Y, Tamura Y, Tokuda Y, Yonekura S, Saito H, Mori T.Department of: Psychiatry and Behaviroal Science, Tokai University School of Medicine, Kanagawa, Japan.
• Do Not Resuscitate (DNR) Orders Getting Emergency Responders to Honor Your WishesByRod
Brouhard, About.com Guide.Updated September 11, 2007
• http://books.google.com/books?id=OU3q2dYS3AQC&pg=PA100&lpg=PA100&dq=implication+of+D
NR+to+nursing&source=bl&ots=yWlhmbHrGN&sig=s9f_jBY2FoVAQl9DhLaiTbmyZ8k&hl=en&ei=s7q 1TbjGJcbX4waw9oWTDA&sa=X&oi=book_result&ct=result&resnum=5&ved=0CC0Q6AEwBA#v=one page&q&f=false
Perceptions ( 3 )Agree (2) Disagree (1 )Not Sure
1DNR means no initiation of CPR.
2DNR order is initiated by the primary consultant
32 Physicians should sign the DNR form together with the primary consultant.
4DNR order is valid for one admission.
5DNR order should be updated on a daily basis.
6No Code or Do Not Attempt Resus is also termed used for No CPR.
7Family should be involved in the care of the patient.
8NUrses has role role to provide support to the family of the dying patient.
9Basic care to patient is continued in patients with DNR orders.
10Poor quality of life of patients before resuscitation is an indication of DNR order
11All comfort measures should continue even the patient is on DNR orders.
12Verbal/ Telephone orders from the treating physicians to nurses is unacceptable.
13Nurses should partcipate in discussing the DNR orders to the family.
14DNR orders should be made to patients when further treatment has no medical benefit.
15In DNR, active management to patient can be withheld.
16Anticipated poor quality of life of the patient after resuscitation needs DNR order.
17No Further Resuscitation (NFR) should be made if patient failed in previous resuscitation.
18No Further Resuscitation (NFR) is ordered when patient had failure of resuscitation.
19 The family members' opinion is not included in decision making as they are unqualified to make such decisions”. 20Nurses discuss end of life issues with the family.
Practices Always Sometimes Never 1 I give the patient medication on time.
2 I monitor my vital signs of my patient hourly.
3 I immediately refer any abnormal findings I see with the patient. 4 I render hygiene to my patient at least twice in my shift. 5 I monitor the vital signs of my patient as needed. 6 I turn the patient every 2 hours
7 I inform the family ( based on their level of understanding ) about the status of the patient.
8 I gave time and privacy to the family of the dying patient.
9 I allow the family members to do any religious rituals/prayers for the patient. 10 I guve complete handover to the incoming staff nurse on duty.
11 I am promoting patients of comfort.
12 I perform comprehensive assessment to my patient. 13 I do proper and timely documentation.
14 I maintain my patient's privacy.
15 I allow the family for open visitation without limiting the number of visitors. 16 I contiuously feed my patient.
17 I suction patient as needed.
18 I adhere with the infection control measures. 19 I render passive ROM.