Ball (2009), advises that a do-not-resuscitate order ( DNR) gives the patient a means to accept or repudiate treatment as part of an advanced directive. This information is then transcribed into the medical record as confirmation of the patient’s wishes. A do-not-resuscitate order (DNR), is an important resolution many patient’s will make at some point in their lifetime. This is a difficult time in life when one must face the impending doom of death. As a result, this can become an ethical issue that nurses and physicians have to face on a continual basis. When a patient makes the decision to become a DNR, this choice should be honored even if a patient decides to have surgery. This writer’s goal is to provide specific understanding of what DNR entails, and the expectations required from nurses and those in leadership if a patient wishes to undergo surgery.
Key concepts of DNR
According to Jones, Moss, and Harris-Kojetin (2011), do-not-resuscitate (DNR) is an order that is written by a physician in the event a patient should suffer from cardiac or respiratory arrest. Hence, this order states that revival of a patient should not be attempted in said instances. As a result, a DNR order should be established on the origin of an advanced directive (AD) from a patient or from an individual that is designated to make informed decisions on behalf of the patient. Feen (2010), states that in most healthcare environments a DNR means that all medical treatment should be halted which would include parenteral fluids as well as antibiotic therapy. Moreover, other facilities may suggest that cardio pulmonary resuscitation (CPR) be initiated in the event of cardiac arrest. In that event, it is vital that nurse leaders familiarize staff with their facilities specific policies regarding DNR guidelines.
When a patient is scheduled to undergo surgery but has a do-not-resuscitate order on file, confusion may result on behalf of the physicians. This may prompt an immediate need for a meeting to verify the exact desires of the patient. For example, in recent months a patient at a facility was scheduled to undergo surgery for a small bowel obstruction. This patient elected to become a DNR immediately upon admission to the hospital. Soon thereafter, it was determined that this individual needed to have a surgical intervention in order to increase his quality of life. The physician whom was to perform this procedure refused to operate unless the patient converted his code status from do-not-resuscitate to full code. Subsequently, this prompted an emergent ethics meeting that would ultimately grant the patient his wish to remain a DNR while undergoing surgery. As a result, the patient was able to undergo the procedure which was a huge success. Resultantly, he was discharged from the hospital to a nursing home where he passed away several weeks later. Loertscher, Reed, Bannon, and Mueller (2010), advise that prior to the 1990s, the...