Contemporary Issues of Nursing and Critical Ill Patient with DNAR Order

Nursing and Do not Attempt Resuscitate Order

Introduction

Do not Attempt Resuscitate

“DNAR” (Do not attempt resuscitate) as an order to avoid all forms of CPR,”Full Code” as any physician order for CPR. "DNAR" is a stand for Do not attempt resuscitate, sometimes called a "No Code". It is legal paper, which is attached to the file of patient. According to "DNAR" form, medical staff cannot apply CPR procedure, when patient is in critical care unit and patient needs CPR (Blais, 2006, pp.83).

A “DNAR” is a request not to give cardiopulmonary resuscitation ("cardiopulmonary resuscitation") if your heart stops and unable to breath and respiration is going to stop. If not given other instructions, hospital staff will try to help all patients whose heart has stopped or who have stopped breathing. You can use an advance directive form or tell your doctor not want to be resuscitated. In this case, your doctor places a DNR order in your medical record. DNR orders are legally accepted by doctors and hospitals in all states (Alters, 2008, pp.15).

Cardiopulmonary Resuscitation (CPR)

Cardiopulmonary resuscitation (CPR) has become the standard treatment for in- hospital cardiac arrest in patients without a "Do not resuscitate" order (Ewens, 2008, pp.14). Cardiopulmonary resuscitation (CPR) or CPR (RCR) is a temporary set of internationally standardized procedure designed to ensure oxygenation of the organs vital when the circulation of the blood of a person suddenly stops, regardless of the cause of the cardiac arrest(Alters, 2008, pp.35) .

The main components of CPR are the activation of emergency medical services within or outside the hospital and the association of chest compressions or "external cardiac massage '(MCE) with artificial ventilation (Nursing Time Net, 2012).

Specific recommendations on CPR vary depending on the patient's age and causes of cardiac arrest. When CPR is implemented in patient, healthcare professional should be trained in the technique and started within a few minutes after cardiac arrest, these procedures can be effective in saving lives (Nursing Time Net, 2012).

In past several years, survival rate of critical ill patient has reduced due to increased rate of DNA orders. CPR technique may prolong the death and suffering without adding to quality of life. Use of CPR in patients unlikely to benefit may be due to a physician's inability to estimate the probability of survival, a desire to offer hope to patients, a fear of litigation12 and poor communication (Life and Health, 2012).

Discussion

Decision about Cardiopulmonary Resuscitation (CPR)

When a patient admits in hospital with critically ill condition, and he/she can need cardiopulmonary resuscitation (CPR) in the future because there are symptoms of cardiac arrest. There are some legal orders which are required at the time of admission of critically ill patient regarding cardiopulmonary resuscitation and DNAR orders (Ewens, 2008, pp.22.)

In clinical practice, patient preference regarding cardiopulmonary resuscitation (CPR) is usually assessed at the time of hospital admission in part due to requirements of the Patient Self-Determination Act. However, formal assessment of patient preferences for quality ...