The Dog Ate My Care Plan…

Just a mom/wife/nursing student extraordinaire trying to make it in the big bad city…

DNR: Do-Not-Resuscitate or Disregard-Nana’s-Requests?

Posted by isntshelovlei on June 20, 2010

Yesterday when we arrived on the floor my patient coded. Actually she wasn’t my patient anymore, I’d had her the last clinical weekend. As she was not documented as a DNR/DNI in her chart, when she coded they of course brought her back. Her husband arrives, goes into her room, and began longingly stroking her (empty) bed…he had already begun to grieve as he thought she was gone. The staff finally did convey to him (there was a language barrier) that his wife was indeed alive and had been transferred to the ICU. Once he (and the family) saw her and the condition she was in, they-were-livid. Though she was breathing on her own, she was in otherwise poor condition. The family blamed the hospital/staff for “doing this to her.” Though the family clearly did not want her to be suffering like that, as far as her chart was concerned, she was a full code. Even though the family would have wanted them to have let her go, they never put that in writing. Interestingly enough, advance directives are supposed to be part of the standard admission process (at least at this facility), so I wonder if the language barrier also came into play (and by the way, where the hell are the “language lines” and interpreters?!?).

Sidenote: I’ve noticed that the code status is often listed in the chart as “Unable to Ascertain.” What exactly does that mean? That you couldn’t understand the patient? Or that you didn’t ask? Now while that explanation might fly with my elderly patient who only spoke Korean (though again where are the supports for our non-English-speaking patients?), or even in an emergency admission, why that same explanation was also in the chart of my 20-year-old patient who walked into the hospital in for an elective surgery—with her mother in tow—is just beyond my comprehension.

In any event, this whole situation is a glaring example of why it is so important to have living wills/advance directives “just in case…” 

Or is it?

This incident, of course stemmed a full discussion about DNR/DNIs, living wills, advance directives, and the like. According to our clinical instructor, even if I have signed all of the proper paperwork stating that I do not want to be resuscitated/intubated/etc., once I am “out” and no longer able to advocate for myself, my family can just come in and overrule me (so-to-speak) and tell the hospital, “No, do everything you can to save her.” If that’s true, then what is the point of these documents??? The way I see it, when I’m “out” is when I actually NEED the DNR to make my wishes known since I am unable to communicate them myself.  But if my documented wishes can just be overturned by my family (or health care surrogate, etc.), someone please explain to me what is the point of formally documenting them? I thought the patient always has the right to refuse a treatment, a medication, or whatever, and I saw the DNR order as a way for a patient to execute that right to refuse even when they are unable to express it themselves.

These types of situations usually bring up talk of the Terri Schiavo case. Mom and Pop wanted this…Hubby wanted that. But what about what Terri wanted? After all it was her life, her body. Shouldn’t she get a say so? Unfortunately, Terri Schiavo did not have an advanced directive so we’ll never really know for sure what she truly would have wanted. I wonder had she documented her wishes, and did not want to be kept alive in that state, would the 15-year battle have still ensued between her parents and her husband? Or would her own wishes have been honored from the beginning?

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One Response to “DNR: Do-Not-Resuscitate or Disregard-Nana’s-Requests?”

  1. THat’s crazy

    I work at a ROSE MEDICAL and we had a similar incident with a patient we actually got sued!

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