Dnr Ethical Dilemmas

In Ethic Case Study 74-Ethical Issues over DNR Orders: “Mr. Warden, a 93-year-old white male, is admitted to Centerville Community Hospital from Centerville Estates Nursing Home. Mr. Warden has had multiple strokes and is only partially responsive to painful stimuli. He's not recognize or responding the nursing staff. The patient has a flexion contractures and a large infected decubitus ulcer over his left sacral area, along with many other medical conditions such as congestive heart failure”(Buchbinder, 2014)."Do-not-resuscitate (DNR) orders have been in use in hospitals nationwide for over 20 years"(Yuen, 2011).

Have you ever thought about what you would do if a family member suddenly stopped breathing? Imagine that you grow up in a small town, the population is 700 people, and one morning you wake up and everyone in the town is dead. On any given day 670 people die of sudden cardiac arrest. Could it be a loved one, someone you care deeply for, or just a complete stranger? The chances are that someone in your family is going to die of sudden cardiac arrest in your lifetime. On average it takes an ambulance no less than seven minutes to reach someone in need, therefore, every adult should know how to administer CPR.

Although nurses have their experience to guide their practice, as the health professional most involved with the client at the end of life, there is a need for review of current assessment tools and management strategies to ensure the care given is evidence based and best practice.

As a patient advocate, the nurse should engage in multidisciplinary support to help family understand the legal aspects and obligation of the power of attorney in making life end decisions and the legal obligations of the Advance Directives. Nurse must be firm in stressing these considerations to family so they may realize the full legal and ethical implications of their decisions.

Nurses: Assist the patients and families to cope with the end-of-life process such as assessing and

DNACPR orders are of considerable concern to ambulance staff, the patient and their families in tackling requests at the end of life (NHS End Of Life Care Programme 2007). A study by Stone et al. (2009) showed nearly all participants had questioned whether interventions performed were correct for the patient when using cardiac life support on patients they thought were terminal. When a patient requires resuscitation and a DNACPR is in place immediate sharing of information is critical. At certain points in the patient care pathway incompatible systems may mean DNACPR requests are not being followed and inappropriate resuscitation being attempted.

Death is inevitable at some point everyone must face it. Whether it is the death of a family member, friend, or a family pet, people are forced to deal with the death. Nurses however have more frequent encounters with death than the average person does. When a patient dies in a healthcare setting his or her nurse is obligated to deal with that as well. They must find ways to cope with the increased amount of death that

Specific, measurable, and realistic outcome: 40% increase in population (aged 10 and above and not working in the medical field) trained in CPR (minimum of 30 minutes hands-only CPR with AED module within the last three

There are a few lawful and moral problems of the do not resuscitate order. The DNR came about by the misunderstanding of CPR. When a person is in cardiac arrest the emergency team is called to their home to give them urgent medical attention. The emergency medical team’s first response is to give the person CPR to help save their life. If an emergency team doesn’t give there patient CPR they could end up dyeing. “During the last decade, the time from cardiac arrest to start of cardiopulmonary resuscitation(CPR)

DNR is a common acronym for do not resuscitate. In healthcare settings this means no cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS) is to be preformed on a patient if their heart stops. Patients usually make this decision when they are of sound mind and able to convey their wishes. But, what happens if their heart does not stop yet they need help? If a patient is a DNR but is clearly in distress, do you attempt to relieve their symptoms? Could you watch someone suffer, while knowing there is an opportunity for help?

WEEK 5 PICO(T) QUESTION 1Good Afternoon Class and Dr. Stephenson,In and out of the hospital high quality cardiopulmonary resuscitation (CPR) is crucial to survival of victims of cardiac arrest. This research topic will focus on implementation of in hospital chest compressions in CPR. It will be based on a comparison of the efficacy of manual compressions and automated chest compressions in relation to survival outcomes. The potential attributes and short comings related to manual and automated chest compression will be reviewed. Intensive care unit (ICU) nurses have to be prepared to implement CPR during a cardiac arrest code. In consideration that patients in the ICU are often only marginally stable it is important that ICU nurses are familiar with their patient’s recent and past medical histories.

Many nurses are regularly confronted with the hopelessness and exhaustion of patients and their families making it difficult for them to find balance between the preservation of life and the enablement of a dignified death. Nurses must acknowledge their own feelings of sorrow, fear, dismay and helplessness and recognize the impact of these emotions in clinical decision making. These distressing pressures may cause a nurse to contemplate intentionally assist in ending a patient's life as a humane and compassionate answer, however; the conventional goals and standards of the nursing profession mitigate against it.

A Do not resuscitate (DNR) order is a legal document written by a licensed physician, which is developed in consultation with the patient, surrogate decision maker, and attending physician. This document indicates whether the patient will receive resuscitative care, cardiopulmonary resuscitation (CPR), or advanced medical directives, in the setting of cardiac and/or respiratory arrest. A DNR can also be referred as a no code when identifying a patient’s resuscitation status. If a patient has an existing DNR it allows the resuscitation team, taking care of the patient, to either withhold or stop any resuscitation measures, and therefore respect the patient’s wishes. Historically, DNR orders did not become active in the care of patients until 1974, when it was identified that patients who received CPR, and survived, had significant morbidities (Braddock & Derbenwick-Clark, 2014). Braddock and Derbenwick-Clark further noted, the American Heart Association (AHA) recommended that physicians, in consultation with the patient, family, and or surrogate, place on the patients chart when CPR was not indicated. This documentation is now what we refer to as the DNR order and has become the standard to allow autonomous respect for patients, and their families, to make informed medical decisions. Therefore, the purpose of this paper is to discuss the legal aspects, ethical issues, and the application surrounding the DNR order.

These symptoms can either manifest themselves as pain, anxiety, dyspnea, and/or delirium. It is a reprioritization of the patients, as well as their families’, preferences regarding their plan of care. The inclination is to optimize the patient’s quality of life by reducing the amount of suffering they experience with their chronic illness (e.g. COPD, cancer, autoimmune disorders).

The American Nurses Association regards active euthanasia inconsistent with the Code for Nurses and is considered ethically unacceptable. It has been the role of a nurse to promote, preserve, and protect human life. As members of the profession, nurses are obligated to offer end of life care, which includes the promotion of comfort for pain and suffering, and foregoing life sustaining treatments. Care does not include deliberately terminating life.