Go Back   Just Us Nurses! A Forum for Nurses. Learn, Share, Discuss, Conversate. The Choice is Yours. Join Us Today! > Nursing Today > Nursing in the News

User Tag List

Reply
 
LinkBack Thread Tools Rate Thread Display Modes
  #1  
Old 12-24-2010, 08:33 PM
DutchgirlRN's Avatar
Owner/Administrator
 
Join Date: May 2008
Location: USA
Posts: 7,923
Thanks: 3,899
Thanked 7,713 Times in 4,409 Posts
My Mood:
Mentioned: 2 Post(s)
Tagged: 2 Thread(s)
Default D.N.R. by Another Name

December 6, 2010, 2:12 pm

By PAULA SPAN Let?s imagine an end-of-life scenario. Your ailing and elderly parent has been admitted to the hospital yet again with a condition she?s not going to recover from. The medical team asks what they should do if her heart stops. She?s always said she didn?t want to die ?hooked up to a bunch of machines,? but you?ve never really explored the details. Besides, though she has a terminal illness, no one has yet mentioned the d-word.


The key question: Should your parent have a D.N.R. order, meaning ?do not resuscitate??


Before you answer, another key question: Would that decision be any clearer, easier or less painful if the order was instead called A.N.D., for ?allow natural death??


Some health care professionals think it might be. Even if the staff?s subsequent actions were exactly the same, if in either case a patient would receive comfort care to relieve pain but wouldn?t undergo cardiopulmonary resuscitation, nomenclature might make a difference.


?It?s only beginning to come to people?s attention,? said Ruth Wittman-Price, nursing department chair at Francis Marion University, who assessed use of the new term in a recent study in the journal Holistic Nursing Practice. ?But a lot of paradigm changes in society start with a language change.?


The phrase ?do not resuscitate? signals an intent to withhold or refuse, she pointed out. ?It says you?re not going to do something.? To ?allow natural death,? on the other hand, connotes permission.

?It doesn?t sound so overwhelming or scary,? said Christian Sinclair, associate medical director at Kansas City Hospice and editor of the Pallimed blog, who sees the term catching on.
Natural foods, natural childbirth ? we?re inclined to favor natural stuff these days.


The palliative care specialists I talked with had very different takes on this wording. Michael Nisco, a proponent, has written a new policy implementing A.N.D. at St. Agnes Medical Center in Fresno, Calif., where he?s medical director of hospice and palliative care.


?Everyone in health care has a different definition of what ?do not resuscitate? means,? he said. It refers to forgoing attempts at cardiopulmonary resuscitation, surely, but does it mean refusing a ventilator? Avoiding the intensive care unit? Such understandings vary not only from one hospital to another, but from one unit or even one shift to the next.


?A new term is free of a lot of that baggage,? said Dr. Nisco.
Perhaps, but some critics see further evasion afoot. We still don?t like talking about death, so we?ll find another way to tiptoe past it.
Besides, ?it brings in a lot of vagueness, and that?s probably its downfall,? said Eric Widera, assistant professor in the University of California, San Francisco geriatrics division. ?When something happens very quickly, physicians and nurses want to know what to do.? He thinks the more specific approach called ?physician orders for life-sustaining treatment? offers more precision.


Personally, I?m not uneasy with the phrase D.N.R., and my own health care proxy (carefully mounted on my refrigerator door for the ambulance crew to find) specifies no resuscitation. But it also authorizes ?the administration of pain-relieving drugs.? Is that ?natural??


Dr. Wittman-Price?s study, based on a non-randomized sample of almost 200 physicians, nurses, medical and nursing students at Hahnemann University Hospital in Philadelphia, is the most recent to show that professionals like the new label. Eighty-three percent of nurses and nursing students, and 78 percent of physicians and medical students, said they?d be ?highly likely? to consent to an A.N.D. order if a loved one was near death.


Missing from this debate, so far, is any data on what patients and families think. ?Allow Natural Death? ? comforting new perspective that eases the burden of decision-making? Or mostly a pointless distinction?
Let?s undertake our own non-randomized research here. If you and other family members have to shoulder this decision for a relative who can no longer make her own wishes clear, would you rather her hospital bracelet read ?Do Not Resuscitate? or ?Allow Natural Death?? Or, at a time of crisis, would that really barely matter?


http://newoldage.blogs.nytimes.com/2...-another-name/
__________________
Send a private message to DutchgirlRN


Joanna MSN, APRN, FNP-BC

Reply With Quote Go to top
Nursing Forum, Nursing Education, Nursing School, Nursing Chat, Nursing Bulletin Board, Nursing Vent, RN, LPN
  #2  
Old 12-24-2010, 08:42 PM
Sabby's Avatar
Moderator
 
Join Date: Aug 2008
Location: In the Foothills to the Blue Ridge Mountains
Posts: 25,917
Thanks: 14,569
Thanked 5,758 Times in 3,936 Posts
My Mood:
Mentioned: 0 Post(s)
Tagged: 4 Thread(s)
Default

The jury is still out on this one, gotta think a little bit more about it!
__________________
"Just for now. The challenge you are facing is just for now. The joy you are celebrating is just for now. The tide never remains in. It recedes to return again. Inhale and give thanks for your blessing. Exhale and release your burden. They are here just for now." ~ author unknown



Live, life, love with all of your heart, it is better than the alternative.

~ Sabby, RN
Reply With Quote Go to top
Nursing Forum, Nursing Education, Nursing School, Nursing Chat, Nursing Bulletin Board, Nursing Vent, RN, LPN
  #3  
Old 12-24-2010, 08:53 PM
Melinurse's Avatar
Senior Member
 
Join Date: Jan 2009
Location: South
Posts: 8,619
Thanks: 5,252
Thanked 6,140 Times in 4,018 Posts
My Mood:
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Default

I don't think it matters what you call it. I have patients who are DNR and the families still in a time of panic dail 911, in spite of educating them and in spite of knowing their loved ones wishes.

I do agree that for the general public the alternative name of " allow a natural death " would be a good idea. It might make the decision a bit easier for them. Less " guilt ".

I really don't care for the " physician orders for life-sustaining treatment " that one , you may as well say start CPR stat during a time of crisis.

Either go with DNR or AND but someone still needs to actually say the word death at some point. We need to educate people that death and dying are not to be feared or tip toed around. It happens to us all at sometime. We may as well make our wishes known and be open about it. I've seen what pussyfooting the topic can do to some families and it tears them apart.

The greater need here is to teach patients and families about the dying process without being morbid and scaring people.

If this response does not make sense, I blame no sleep in 24 hours and still running on adrenaline. Excuse any spelling errors too please. Then again I may have a whole other opinion after some sleep.
__________________
Beauty does not lie on the brands you dress in, the cars you roll in and the crowd you hang out with; its the pureness of your honest and loving heart and soul!
Reply With Quote Go to top
The Following 5 Users Say Thank You to Melinurse For This Useful Post:
Nursing Forum, Nursing Education, Nursing School, Nursing Chat, Nursing Bulletin Board, Nursing Vent, RN, LPN
  #4  
Old 12-24-2010, 11:33 PM
JennaRN1006's Avatar
Senior Member
 
Join Date: Jun 2008
Location: Somewhere over the rainbow...
Posts: 892
Thanks: 1,410
Thanked 873 Times in 574 Posts
My Mood:
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Default

I think this is just another way for us to be Politically Correct. It drives me a little nut so. One more thing to walk on egg shells for. If you have a good physician, they will explain to patients and families what end of life is and what a DNR is...I also feel that the general public doesnt know what CPR entails. Sure they see it on TV or in a CPR class...but they dont get to see the hard chest pounding and bone crushing sounds. Now am I saying never do CPR, no. But in end life care, I think things need to be put in perspective.

I was in Nursing school...just started my first semester. Grammy was having problems with her heart. She had to go in for an angiogram. I flat out asked her what she wanted to do if her heart stopped. My grandmother wasnt ready to hear it, nor were my aunt and mom. They shooed me away so fast. Two weeks later, grammy was admited with CHF exacerbation and PNA. The hospital intubated her when we werent there, she went into respiratory failure. It was there we made her a DNR and said if her heart stopped, she should not have CPR or life saving measures. She died a month later...to this day my mom wishes I had pushed more for the DNR talk.

Instead of worrying about AND vs DNR, we should be worrying about educating the public....and docs to discuss code status sooner. In my field, I feel like it should be addressed when you have the diagnosis. Not so much should you be a DNR, but if something goes wrong do you want life saving measures. I hate when a pt comes into the hopsital with whatever issue, and then the docs say im sorry there is no more we can do, do you want to be a DNR? Im exaggerating but waiting til right before they die, I dont feel is always the best time...am i making sense?
__________________
Reply With Quote Go to top
The Following 4 Users Say Thank You to JennaRN1006 For This Useful Post:
Nursing Forum, Nursing Education, Nursing School, Nursing Chat, Nursing Bulletin Board, Nursing Vent, RN, LPN
  #5  
Old 12-25-2010, 12:21 AM
Kylee's Avatar
The Irish Fireball
 
Join Date: Jun 2008
Location: 1 E. 161st St. Bronx, NY
Posts: 6,479
Thanks: 2,298
Thanked 3,868 Times in 2,710 Posts
My Mood:
Mentioned: 0 Post(s)
Tagged: 2 Thread(s)
Default

You're making sense, Jenna. I have to agree with both you and Meli.

I've seen doctors explain end of life care to families who don't want to hear it. Suddenly, a DNR patient becomes a full code because family wants them to have everything done.

Long before I started Nursing, I sat down with both parents and told them "I know you don't want to hear this, but...." and then I told them I didn't want to die hooked up to machines doing everything for me. I still don't. Mom has my AD in her lockbox.

When the time came when we had to decide for Dad, Mom, my brothers and I all made the decision that we had to abide by his wishes, which were to DNR. We terminated the life support when we found out there was no hope of recovery. Dad had made his intentions known, and we all loved him enough to respect his decision. Yeah, it sucked... but as I told my Mom... I'd rather tell him I love him, kiss him goodbye and have him go now than have him stuck in a nursing home for however many years till his heart stops, and having my heart break a little bit more every time I have to visit and leave him.

So, yeah... a DNR by any other name... is still a DNR...
__________________


Pinstripes are never out of season...

Kylee, BSN, RN
Reply With Quote Go to top
The Following 4 Users Say Thank You to Kylee For This Useful Post:
Nursing Forum, Nursing Education, Nursing School, Nursing Chat, Nursing Bulletin Board, Nursing Vent, RN, LPN
  #6  
Old 12-25-2010, 06:07 AM
Sabby's Avatar
Moderator
 
Join Date: Aug 2008
Location: In the Foothills to the Blue Ridge Mountains
Posts: 25,917
Thanks: 14,569
Thanked 5,758 Times in 3,936 Posts
My Mood:
Mentioned: 0 Post(s)
Tagged: 4 Thread(s)
Default

I have thought about this more but I believe the term AND is too wishwashy and open to fail. Heck even the term DNR still is vague to some. That is why the MOST form around here specifically has documented the person's wishes.

Allow a Natural death has too many grey areas I believe. Do not rescusitate at least states something to the patient's wishes.

I do pray that the MOST for becomes country wide. They carry it with them everywhere. To hospitals and MD appt's. Everything about their wishes is documented on this. No grey areas, it is specific to each person.

I would prefer the DNR-DNI stays until the MOST form takes off.

When you are dying from any nasty illness/ disease there is nothing natural about that. Allow a natural death kinda irks me.

I mean why not have NCNI= no code no intervention or LMD let me die???

Just my thoughts
__________________
"Just for now. The challenge you are facing is just for now. The joy you are celebrating is just for now. The tide never remains in. It recedes to return again. Inhale and give thanks for your blessing. Exhale and release your burden. They are here just for now." ~ author unknown



Live, life, love with all of your heart, it is better than the alternative.

~ Sabby, RN
Reply With Quote Go to top
The Following 3 Users Say Thank You to Sabby For This Useful Post:
Nursing Forum, Nursing Education, Nursing School, Nursing Chat, Nursing Bulletin Board, Nursing Vent, RN, LPN
  #7  
Old 12-25-2010, 07:50 AM
dria's Avatar
Senior Member
 
Join Date: Jun 2008
Location: burbs
Posts: 1,504
Thanks: 1,001
Thanked 1,498 Times in 878 Posts
My Mood:
Mentioned: 0 Post(s)
Tagged: 3 Thread(s)
Default

DNR....AND....I don't care WHAT it's called....bottom line for me is that if that name changes gets patients and families to start thinking about and making end-of-life decisions, it's a good thing in my book.
__________________
Dria, RN, CCM
Reply With Quote Go to top
The Following 2 Users Say Thank You to dria For This Useful Post:
Nursing Forum, Nursing Education, Nursing School, Nursing Chat, Nursing Bulletin Board, Nursing Vent, RN, LPN
  #8  
Old 12-25-2010, 08:06 AM
Melinurse's Avatar
Senior Member
 
Join Date: Jan 2009
Location: South
Posts: 8,619
Thanks: 5,252
Thanked 6,140 Times in 4,018 Posts
My Mood:
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Default

Quote:
Originally Posted by Sabby View Post
I have thought about this more but I believe the term AND is too wishwashy and open to fail. Heck even the term DNR still is vague to some. That is why the MOST form around here specifically has documented the person's wishes.

Allow a Natural death has too many grey areas I believe. Do not rescusitate at least states something to the patient's wishes.

I do pray that the MOST for becomes country wide. They carry it with them everywhere. To hospitals and MD appt's. Everything about their wishes is documented on this. No grey areas, it is specific to each person.

I would prefer the DNR-DNI stays until the MOST form takes off.

When you are dying from any nasty illness/ disease there is nothing natural about that. Allow a natural death kinda irks me.

I mean why not have NCNI= no code no intervention or LMD let me die???

Just my thoughts

I have to disagree to a certain extent, although I totally see where you are coming from. Especially in our line of work. But when it comes to the average person with no medical training the more " politically correct " would allow the discussion to open up. After this week, I am all for anything that gets families talking about their wishes at time of death.

Allow Natural Death does have gay areas to it. But, at least it would get people talking. Like Jenna said, it is just another way to be politically correct and that part bothers me too. It is what it is. It is just DNR by another name.

Jenna after this last week, I love what you wrote in that last paragraph. Get those families talking about their wishes. Call it what you will , but we need to be more proactive in educating the public.
__________________
Beauty does not lie on the brands you dress in, the cars you roll in and the crowd you hang out with; its the pureness of your honest and loving heart and soul!
Reply With Quote Go to top
The Following 2 Users Say Thank You to Melinurse For This Useful Post:
Nursing Forum, Nursing Education, Nursing School, Nursing Chat, Nursing Bulletin Board, Nursing Vent, RN, LPN
  #9  
Old 12-25-2010, 02:34 PM
Sabby's Avatar
Moderator
 
Join Date: Aug 2008
Location: In the Foothills to the Blue Ridge Mountains
Posts: 25,917
Thanks: 14,569
Thanked 5,758 Times in 3,936 Posts
My Mood:
Mentioned: 0 Post(s)
Tagged: 4 Thread(s)
Default

Great responses and a great read
__________________
"Just for now. The challenge you are facing is just for now. The joy you are celebrating is just for now. The tide never remains in. It recedes to return again. Inhale and give thanks for your blessing. Exhale and release your burden. They are here just for now." ~ author unknown



Live, life, love with all of your heart, it is better than the alternative.

~ Sabby, RN
Reply With Quote Go to top
The Following User Says Thank You to Sabby For This Useful Post:
Nursing Forum, Nursing Education, Nursing School, Nursing Chat, Nursing Bulletin Board, Nursing Vent, RN, LPN
  #10  
Old 12-25-2010, 06:15 PM
Poliopioneer's Avatar
Senior Member
 
Join Date: Jun 2008
Posts: 7,477
Thanks: 5,417
Thanked 5,786 Times in 3,765 Posts
My Mood:
Mentioned: 0 Post(s)
Tagged: 2 Thread(s)
Default

How about NHM - No Heroic Measures?

I never pussyfooted around the idea of death. Mortality is a simple fact and part of the life process. When my kids were old enough to understand it, I answered their questions as best I could. I also tried to teach them what my mother taught me: Life Goes On. They know my wishes, especially if my mind stops functioning. Neither of them is particularly fond of this PC business. ITA that people should stop trying to hide from the idea that anything that is born, eventually dies.
Reply With Quote Go to top
The Following User Says Thank You to Poliopioneer For This Useful Post:
Nursing Forum, Nursing Education, Nursing School, Nursing Chat, Nursing Bulletin Board, Nursing Vent, RN, LPN
Reply

Bookmarks

Thread Tools
Display Modes Rate This Thread
Rate This Thread:

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are On


All times are GMT -5. The time now is 05:49 PM.


Powered by vBulletin® Version 3.7.2
Copyright ©2000 - 2019, Jelsoft Enterprises Ltd.
Search Engine Optimization by vBSEO 3.6.0
User Alert System provided by Advanced User Tagging v3.2.4 (Lite) - vBulletin Mods & Addons Copyright © 2019 DragonByte Technologies Ltd.

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information:
verify here.



Search only trustworthy HONcode health websites:

     
//-->