When a patient faces a life-threatening diagnosis or they are nearing the end of life, they and their doctors have to have some tough conversations. But there's one tough conversation you can encourage your patient to have with their family members and caregivers to help make things easier in a time of emergency: whether or not the patient wants to be resuscitated.
When having the Do Not Resuscitate (DNR) discussion, your goal is to educate where needed and explain to the patient and their loved ones that this is a conversation they need to have and determine the results for themselves. Here, we outline ways you could help.
Being Prepared Doesn’t Mean Losing Hope
If necessary, explain to the patient or family members that simply having this kind of conversation with loved ones doesn't mean giving up hope. It just means being prepared by making sure everyone knows what the patient's expectations and desires are, and sparing others from having to guess what to do at a time when the unthinkable is happening.
Ensure the patient understands their health status or diagnosis thoroughly. Do they know what cardiopulmonary resuscitation (CPR) entails and what can happen during CPR considering their condition and age? What kinds of measures would they want taken? Do they have certain preferences they want honored for religious or other reasons? Would they want to be resuscitated or would they like to complete a DNR?
What a DNR Covers
Educate the patient and their family members about what a DNR is and isn’t. They should understand the DNR is a legal medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if the patient’s heart stops or they stop breathing. It doesn’t affect treatments other than what would be required for intubation or CPR. Patients who worry filling out a DNR will mean they’ll be denied certain treatments like chemotherapy or medications like those for pain will need reassurance that this is not the case.
Health Information at the Ready
Explain the importance of a DNR. Emergency responders are often left to make immediate and often life-changing decisions with only the information they have on hand. Having a DNR on file can be critical. Who should have access to it and where should it be kept on record (doctor’s office, hospitals, etc.)?
Encourage patients to share the information about their wishes and the existence of their DNR with family members and friends, or anyone else who might be with them regularly. This way, if they are unconscious, there may be others around them who can inform emergency responders that there is a DNR in place.
The patient could also consider getting a medical alert bracelet or necklace with the "DNR" logo on it. And they may want to designate someone they trust to give healthcare power of attorney to, so that person can act in their best interests if they can’t speak for themselves.
In Support of Patients
Think of having the DNR discussion with your patients as another way you can demonstrate your desire to ensure they get the best possible care no matter what the circumstance is or who the provider may be.