Nursing Care and Do-Not-Resuscitate (DNR) Decisions

Summary

The American Nurses Association's position statement on Do Not Resuscitate (DNR) decisions emphasizes ethical guidance for nurses in complex decision-making scenarios. It highlights the importance of maintaining trust, respecting patient self-determination, and ensuring high-quality care regardless of a patient's DNR status. The statement outlines four ethical considerations and offers recommendations for nurses to advocate for collaboration and evidence-based practices. A case study featuring an 86-year-old patient who wishes to avoid heroic measures serves as a focal point for understanding the importance of communication and interdisciplinary involvement in honoring patient wishes.

Takeaways

• 😀 The American Nurses Association (ANA) provides ethical guidance for nurses regarding Do Not Resuscitate (DNR) decisions.
• 😀 Nurses play a critical role in initiating discussions about DNR orders with patients, families, and healthcare teams.
• 😀 Patients with DNR orders should receive the same quality of care as any other patient; care should not diminish due to their DNR status.
• 😀 Establishing trust between nurses and patients is essential in providing quality nursing care, especially in DNR situations.
• 😀 Nurses are encouraged to actively participate in the decision-making process concerning DNR orders and related interventions.
• 😀 Respecting a patient's right to self-determination is a fundamental ethical consideration in nursing practice.
• 😀 Effective collaboration and communication among healthcare team members are vital when addressing DNR decisions.
• 😀 The use of acronyms like DNR can lead to confusion; clear communication is recommended to avoid misunderstandings.
• 😀 DNR orders may require reconsideration in different clinical circumstances, such as prior to surgeries.
• 😀 The position statement includes a case study of an 86-year-old male patient, highlighting the importance of understanding and respecting patient wishes.

Q & A

What is the purpose of the American Nurses Association's position statement on DNR decisions?

The purpose is to provide ethical guidance for nurses in DNR decision-making processes and to recommend clinical and policy changes.

Who contributed to the drafting of the position statement?

The position statement was drafted by members of the ANA Center for Ethics and Human Rights, specifically doctors Heather Fitzgerald, Nelda Godfrey, and Catherine Schroeder.

What role do nurses play in DNR discussions?

Nurses advocate for and actively initiate discussions about DNR decisions with patients, families, and the healthcare team.

What are the four chief ethical considerations in DNR situations according to the ANA?

The considerations are: 1) Establishing trust and providing quality care, 2) Participating in appropriate interventions, 3) Respecting the patient's right to self-determination, and 4) Fostering collaboration and open communication.

Why is clear communication important in DNR decisions?

Clear communication is vital because misunderstandings surrounding acronyms like DNR can lead to confusion, and clarity helps ensure that patient wishes are accurately understood and respected.

How should nurses respond to potential ethical conflicts arising from DNR decisions?

Nurses should be aware of potential conflicts and may need to transfer care to another nurse if they experience moral distress regarding DNR orders.

What recommendations does the ANA make regarding DNR decision-making?

The recommendations include respecting human dignity, ensuring responsibility in interventions, advocating for interdisciplinary collaboration, and seeking knowledge about evidence-based practices related to DNR orders.

What is the significance of the case study presented in the video?

The case study involving Mr. L illustrates the complexities of DNR decisions and encourages nurses to consider various factors when communicating with patients about their wishes.

What key questions should nurses ask Mr. L regarding his DNR wishes?

Nurses should ask how Mr. L's wishes can be validated, what strategies to implement to respect those wishes, who should be involved in care discussions, and what communication methods to use with the healthcare team.

Where can one find the full position statement and references related to DNR decisions?

The full position statement and references can be found at nursingworld.org/ethics.