When sufferers have a do-not-resuscitate (DNR) order, it means they’ve chosen to not obtain cardiopulmonary resuscitation (CPR). However hospital nurses report important variations in the way in which DNR orders are perceived or acted on in medical observe, reviews a survey examine within the January difficulty of the American Journal of Nursing (AJN).
“Whereas the definition of DNR may appear simple, its interpretation in medical observe could be difficult,” based on 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, Ph.D., 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. Revealed pointers outline DNR by way of deciding to withhold CPR solely, nevertheless, research have proven healthcare suppliers and sufferers could also be confused in regards to the which means and implications of DNR orders. An American Nurses Affiliation place assertion 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.”
Primarily based on her experiences, medical 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 supplied 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 which means no different aggressive lifesaving measures.
- The nurses reported conditions the place healthcare staff members disagreed about how DNR orders affected medical care and duties. One nurse identified that having a DNR does not imply the individual is a hospice affected person: “It does not imply that you simply’re not going to do all the pieces that you’d for anyone else.”
- The nurses encountered household conflicts and confusion about DNR orders, significantly when the affected person’s situation modified, and sufferers and members of the family generally 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 staff members, and variations in function expectations. “Lack of readability and settlement about what DNR means in observe has a far-reaching impression,” Dr. Kelly and colleagues write. “It is vital for nurses to grasp that DNR orders don’t substitute for plans of care.”
Maureen Shawn Kennedy, MA, RN, FAAN, editor in chief of AJN, notes that the examine is necessary as a result of, “Everybody—nurses, physicians, and households—must be on the identical web page in understanding the extent of care a affected person will obtain.”
Dr. Kelly, Baker, and coauthors imagine that nurses play a key function 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 way of observe, training, advocacy and coverage, and analysis,” the researchers conclude. “After 40 years as one of the well known medical abbreviations, DNR ought to imply ‘don’t resuscitate,’ not an acronym that will diminish care.”
Patricia A. Kelly et al. Authentic Analysis: Nurses’ Views on Caring for Sufferers with Do-Not-Resuscitate Orders, AJN, American Journal of Nursing (2020). DOI: 10.1097/01.NAJ.0000731652.86224.11
Wolters Kluwer Well being
What does ‘DNR’ imply? Various interpretations could have an effect on affected person care (2020, December 23)
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