Declining resustation or do-not-resuscitate order (DNR), also known as no code or allow natural death, is a legal order, written or oral depending on country, indicating that a person does not want to receive cardiopulmonary resuscitation (CPR) if the person's heart stops beating..
DNR order is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating.
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The law has a lot to say about personal decision-making. For example, people have the legal right to make their own health care decisions. However, poor health can jeopardize people’s ability to exercise their legal rights.
Safeguarding these rights requires advance thinking and planning. Sudden or chronic illness can cause profound weakness and confusion, which makes people vulnerable and can lead to the unwilling loss of control.
A do-not-resuscitate (DNR) order placed in a person’s medical record because CPR is not attempted, other resuscitative measures such defibilation and artificial respirations by insertion of a breathing tube will also be avoided.
This order has been useful in preventing unnecessary and unwanted invasive treatment at the end of life. The success rate of CPR near the end of life is extremely low.
Ethical dilemmas occur when a patient with a DNR attempts suicide and the necessary treatment involves ventilation or CPR. In these cases it has been argued that the principle of beneficence takes precedence over patient autonomy and the DNR can be revoked by the physician.
Another dilemma occurs when a medical error happens to a patient with a DNR. If the error is reversible only with CPR or ventilation there is no consensus if resuscitation should take place or not.
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Nursing care is directed toward meeting the comprehensive needs of patients and their families across the continuum of care. This is particularly vital in the care of patients and families at the end of life to prevent and relieve the cascade of symptoms and suffering that are commonly associated with dying.
Nurses are leaders and vigilant advocates for the delivery of dignified and humane care.
Nurses must advocate for and play an active role in initiating discussions about DNR with patients, families, and members of the health care team.
The DNR decision should reflect what the informed patient wants or would have wanted. This demands that communication about end-of-life wishes occur among all involved parties (patient, health care providers, and family; the latter as defined by the patient) and that appropriate DNR orders be written before a life-threatening crisis occurs.
Care plans for patients with DNR orders should also attend to such patient needs as symptom relief, spiritual care, and the patient's preferred site of terminal care (eg, hospital or hospice). Whether these issues are addressed can be considered an indicator of the quality of end-of-life care.
During end-of-life care, the nursing care planning revolves around controlling pain, preventing or managing complications, maintaining quality of life as possible, and planning in place to meet patient’s and/or family’s last wishes
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