DNR (Do Not Resuscitate) Information: Complete Guide & FAQs

SilverMangos Team | January 28, 2024

Key Takeaways

A DNR Order (Do Not Resuscitate Order) is a legal document that instructs healthcare providers not to perform CPR if a person’s breathing or heart stops.
DNR orders are used by individuals with terminal illnesses or severe health conditions who wish to die naturally without aggressive medical interventions.
Implementing a DNR requires clear communication with healthcare providers, understanding of the patient’s health status, and consideration of the patient’s quality of life and wishes.
Healthcare professionals play a crucial role in explaining the implications of DNR orders and ensuring that a patient’s wishes are respected and followed.
It’s important to understand the legal and ethical considerations of DNR orders, as well as the differences between DNR orders and other advance directives such as living wills.

Decoding Do not resuscitate order: A Lifesaver’s Dilemma

What Is a do-not-resuscitate order?

A Do Not Resuscitate (DNR) order is more than just a piece of paper; it’s a deeply personal decision made by a patient or their authorized representative. This directive tells doctors, nurses, and emergency personnel that in the event of a cardiac or respiratory arrest, the patient has chosen not to receive cardiopulmonary resuscitation (CPR). It’s a choice that often comes after much thought, discussion, and reflection on what quality of life means to the individual.

Most importantly, a DNR is not a one-size-fits-all decision. It’s tailored to each person’s health condition and personal values. It’s about the right to choose how one’s life should end, and it’s a choice that deserves respect and understanding.

When and How to Implement a DNR

To implement a DNR order, the first step is having a conversation with your healthcare provider. This discussion should cover your health status, treatment options, and the risks and benefits of CPR. Once the decision is made, the DNR order must be written by a doctor and placed in your medical chart.

Discuss with your healthcare provider: Understand your health condition and prognosis.
Consider your quality of life: Reflect on what matters most to you at the end of life.
Make the decision: If you decide a natural death is what you prefer, inform your doctor.
Get it in writing: Your doctor will write the DNR order and include it in your medical records.

Besides that, it’s essential to inform your family and any caregivers about your DNR order so they can support your wishes. If you’re in a hospital, remind the staff regularly about your DNR status, as it can get overlooked during shift changes or transfers between departments.

The Impact of DNR on Patient Care

A DNR order has a profound impact on the type of care you receive. It means that healthcare providers will not attempt CPR, but it does not mean that you’ll receive less care. In fact, the focus shifts to providing comfort, managing pain, and supporting your emotional and spiritual needs. Your care becomes about enhancing the quality of your remaining life.

The Role of Healthcare Professionals

Healthcare professionals have the responsibility to ensure that your DNR order is respected and followed. They also have a duty to educate and support you and your family through this decision. This includes clear communication about what a DNR order does and does not include and how it will affect your overall care plan.

Therefore, it’s crucial for healthcare providers to be transparent and compassionate, helping to align medical interventions with your values and wishes.

Creating a DNR Order: A Step-by-Step Guide

If you’ve decided that a DNR order aligns with your wishes, it’s essential to know how to create one properly. This isn’t just a casual conversation; it’s a formal process that ensures your desires are legally recognized and will be followed by healthcare professionals. Here’s a simple guide to help you through the process:

Start the conversation with your doctor or healthcare provider about your end-of-life wishes.
Understand the implications of a DNR order, including what it means for emergency care and life-sustaining treatments.
Ensure the DNR order is documented in writing and signed by your physician, which makes it an official medical order.
Communicate your decision to family members, loved ones, and caregivers to ensure everyone is aware of your wishes.
Keep the DNR order in an easily accessible place, and consider wearing a DNR bracelet or carrying a DNR card in your wallet for emergency situations.
Review and update your DNR order as needed, especially if your health condition changes.

Remember, creating a DNR order is a personal choice and should reflect your values and beliefs about quality of life and medical intervention.

Common Misconceptions About DNR Orders

When it comes to DNR orders, there’s a lot of confusion and misinformation. Let’s clear up some of the most common misconceptions:

Firstly, having a DNR does not mean you will be denied other forms of medical care. It specifically refers to CPR in the event your heart stops beating or you stop breathing. You’ll still receive treatment for pain, infections, and other medical needs unless you specify otherwise in an advance directive.

Another misconception is that DNR orders are only for the elderly or those at the end of life. In reality, anyone with a chronic or serious health condition may consider a DNR based on their personal preferences and medical advice.

Lastly, some believe that a DNR order is permanent and cannot be changed. The truth is, you can update or revoke your DNR at any time as long as you are mentally capable of making that decision.

A DNR order only applies to CPR, not other medical treatments.
People of any age with serious health conditions can have a DNR order.
You can change or cancel your DNR order at any time if you wish.

Clarifying the Scope of Treatment

Understanding the intricacies of a Do Not Resuscitate (DNR) order is essential for making informed healthcare decisions. A DNR order primarily focuses on whether or not an individual desires cardiopulmonary resuscitation (CPR) in the event of a cardiac or respiratory arrest. While it is a crucial aspect of end-of-life care planning, it is equally important to recognize that a DNR order does not encompass a comprehensive range of medical treatments.

In addition to CPR preferences, individuals should consider and clearly communicate their preferences for other medical interventions. A DNR order, by itself, does not address treatments such as mechanical ventilation, artificial nutrition, or hydration. These aspects of medical care should be explicitly outlined in other advance directives, such as a living will.

For a more comprehensive approach to end-of-life care planning, individuals are encouraged to discuss their healthcare preferences with their healthcare providers, family members, and legal professionals. This ensures that all relevant aspects of medical treatment are considered and documented appropriately in advance directives, providing a clearer roadmap for healthcare decision-making in critical situations.

Addressing Fears and Concerns of Patients and Families

It’s natural for patients and their families to have fears and concerns about DNR orders. Some worry that it means giving up on life or that medical staff won’t provide adequate care. It’s important to reassure everyone involved that a DNR order is about respecting the patient’s wishes and ensuring their dignity and quality of life at the end of their journey.

Having open and honest conversations can help alleviate concerns and ensure that everyone is on the same page regarding the patient’s end-of-life care.

Initiating DNR Discussions

Guidelines for Starting the Conversation

Discussing DNR orders can be challenging, but it’s a necessary conversation. Start by choosing a comfortable setting and allowing plenty of time to talk without interruptions. Be clear and direct about the purpose of the conversation, and provide information about what a DNR order is and how it can be part of an overall care plan.

Handling Emotions and Resistance

Emotions can run high during these discussions. Some people may be resistant or upset at the thought of a DNR order. It’s important to listen to their concerns, provide support, and explain the reasons behind considering a DNR. Remember that these conversations might need to happen in stages, giving everyone time to process the information and come to terms with the decision.

Ensuring Clarity and Comprehension

Make sure that everyone involved clearly understands what a DNR order entails. Use simple language and avoid medical jargon. Confirm comprehension by asking family members to explain back to you what they’ve understood about the DNR order. This ensures that everyone is making informed decisions.

Zones of Applicability for DNR Orders

In-Hospital vs. Out-of-Hospital DNR

DNR orders can vary depending on where you are. In-hospital DNR orders are used when you’re admitted to a hospital, while out-of-hospital DNR orders are for situations where emergency medical services (EMS) might be called to your home or another location. It’s important to understand the differences and ensure that your DNR order is recognized in both settings if that’s your wish.

Emergency Medical Services and DNR

EMS personnel are trained to look for DNR orders in emergency situations. If you have an out-of-hospital DNR order, it’s crucial to keep it in a place where EMS can easily find it, like on your refrigerator or in your wallet. This helps ensure that your wishes are followed, even if you’re unable to communicate.

Preparing for a World Beyond CPR

Incorporating Palliative and End-of-Life Care Options

Advanced Directives and DNR: Ensuring Wishes are Respected

Advanced directives, including DNR orders, living wills, and healthcare power of attorney, are tools that ensure your healthcare wishes are known and respected. They speak for you when you can’t speak for yourself. It’s crucial to have these documents in place and to communicate your wishes to your loved ones and healthcare providers.

Here’s what you need to do to make sure your wishes are followed:

Complete an advance directive that outlines your wishes for healthcare and end-of-life care.
Discuss your decisions with your family and healthcare proxy, if you have one.
Provide copies of your advance directives to your healthcare providers, family, and healthcare proxy.
Review and update your directives periodically, especially if your health status or wishes change.

Remember, it’s about taking control of your healthcare decisions and making sure they align with your values and wishes.

Best Practices for Documentation and Compliance

Establishing and adhering to best practices for the documentation and compliance of Do Not Resuscitate (DNR) orders is critical to uphold the ethical and legal aspects of end-of-life care. Healthcare providers play a pivotal role in navigating these complexities, and adherence to established protocols is paramount to ensure the wishes of patients are respected.

Clear and Accurate Documentation: Healthcare professionals must maintain meticulous and clear documentation of DNR orders in the patient’s medical records. This documentation should explicitly outline the patient’s preferences regarding resuscitation, providing a transparent reference for all members of the healthcare team involved in the patient’s care.
Informed Consent and Communication: Obtaining informed consent is a fundamental aspect of proper documentation. Healthcare providers should engage in thorough conversations with patients, ensuring they understand the implications of a DNR order. This involves discussing the potential consequences and alternatives, fostering open communication to address any concerns or questions the patient may have.
Legal Validity: DNR orders must adhere to legal requirements, varying by jurisdiction. It is essential for healthcare providers to stay informed about the specific laws governing advance directives and DNR orders in their region. This includes understanding the criteria for a valid DNR order, the role of witnesses, and any specific forms or processes mandated by local laws.
Regular Review and Updating: Patient preferences may change over time, especially in the context of evolving health conditions. Healthcare providers should routinely review and, if necessary, update DNR orders to accurately reflect the patient’s current wishes. This may involve discussions during regular medical check-ups, hospital admissions, or when a significant change in health status occurs.
Collaboration with Multidisciplinary Teams: Communication and collaboration among members of the healthcare team are essential for proper compliance with DNR orders. This includes involving nurses, social workers, and other healthcare professionals in discussions about the patient’s end-of-life care preferences, ensuring a holistic approach that respects the patient’s wishes.

Research underscores the importance of proper documentation and compliance in end-of-life care. A study published in the Journal of Medical Ethics found that clear documentation of DNR orders contributes to better communication among healthcare providers, reducing the likelihood of misunderstandings and ensuring the appropriate implementation of the patient’s wishes.

By adhering to these best practices, healthcare providers contribute to a more transparent, patient-centered, and ethically sound approach to end-of-life care planning, fostering trust between patients, their families, and the healthcare team.

Recording DNR Orders: Who, What, Where, and How

Recording a DNR order correctly is critical. It should be done by a healthcare provider in consultation with the patient or their legal representative. The order must be included in the patient’s medical record. Here’s how to ensure it’s done properly:

Who: The DNR order must be written by a licensed physician after discussing it with the patient or their representative.
What: Clearly state that no CPR should be administered if the patient’s breathing or heart stops.
Where: The DNR order should be included in the patient’s medical chart and easily accessible to all healthcare providers.
How: Ensure that the DNR order is properly signed and dated according to state laws and hospital policies.

Maintaining Compliance with State and Hospital Policies

Compliance with state and hospital policies is non-negotiable when it comes to DNR orders. Each state has its own regulations regarding DNR orders, and hospitals have policies to ensure these orders are recognized and followed. It’s vital for healthcare providers to be well-versed in these rules to maintain the integrity of the patient’s wishes.

Frequently Asked Questions (FAQ)

There are always questions when it comes to DNR orders. Let’s address some of the most common ones to provide clarity.

Can a DNR be reversed?

Yes, a DNR order can be reversed or canceled at any time by the patient or their legal representative. This decision should be communicated immediately to all healthcare providers involved in the patient’s care.

What happens if there is no DNR in place during an emergency?

If there is no DNR order in place during an emergency, healthcare providers will typically perform CPR and other life-saving measures by default. This underscores the importance of having a DNR order if you wish to avoid such interventions.

How does a DNR differ from a living will?

A DNR is a specific medical order that applies to CPR, while a living will is a broader document that outlines a person’s wishes regarding various life-sustaining treatments. A living will can include a DNR preference, but it also addresses other interventions like mechanical ventilation and artificial nutrition.

Are DNR orders recognized across state lines?

DNR orders are generally recognized across state lines, but it’s important to be aware of any specific requirements or forms that different states may have. When traveling, carry a copy of your DNR order and consider wearing a DNR bracelet.

How can healthcare providers advocate for patients with DNR orders?

Healthcare providers can advocate for patients with DNR orders by ensuring that the orders are clearly documented and understood by the entire healthcare team. They should also educate patients and families about what a DNR order means and support them in their decision-making process.

What happens when I chose DNR and DNI? Will my caretakers stop taking care of me?

DNR /DNI stands for do not resuscitate and do not intubate. In other words do not rescue me if I am dead and do not intervene in my dying process.

Of course they’re are many answers to your the question. It all depends on what else you choose with it , but you can have a say in what you want in terms of treatments at the end off life. Controlling the end of your life so that you have quality of life and enjoy whatever time you have left is very important but tough to come to terms with. What you want to achieve is to enjoy your life while you still can.

If you choose to go into hospice the choice of DNR/DNI is inherent or built in so to speak. Hospice is given at the end of life when it is estimated you have six months or less of life left. And it is primarily concerned with maintaining quality of life and comfort. There will be no transferring to an ER of no further treatments commenced unless they are to maintain Quality of life and or subdue pain.

Unfortunately hospice is a medical service infrequently used and many patients do not get to enjoy its benefits long enough. The two best examples of this are Mr and Mrs Jimmy Carter. He chose to go into hospice over a year ago and is still alive as of the writing of this article Jan 2024. Mrs Carter unfortunately had dementia and entered hospice too late, and died two to three days after her starting her hospice care. She unfortunately never got to enjoy there benefits of hospice. There is good evidence in the medical literature that those that accept hospice have better quality of life and may even live a little longer than expected.

If you are to in a situation where you do not need to enter hospice you can still chose DNR/DNI. You are simply stating that in case of an emergency or if you are found”down” and unresponsive you do not wish to be to be resuscitated. These are instructions to your care takers not to rescue you if you are found down.

What happens if I am ill or unconscious, but not dead? Will they still take care of me?

By choosing DNR your care takers are following your wishes an taking care of you. If you choose this option you will still have antibiotics if needed, you will have meals , your pain and suffering will be taken care of. Caretakers have ethical , moral and legal duties to make sure you are comfortable and taken care of. They can’t ignore you and they should not. If you feel ignored mention it to someone and you will see how rapidly there attitudes will change.

It is true that if your breathing stops or heart stop beating in the middle of any medical procedure(surgery, or invasive procedures such as coronary angiogram). Your doctors must rescue you. In other words it is assumed the procedure or surgical intervention precipitated the medical emergency and Physician/Surgeon must intervene. But if your heart stops beating or you stop breathing in a hospital room in any ward or emergency room no one has to intervene if you have chosen DNR/DNI. They can let nature takes it s course. And that is what you are choosing just letting nature takes its course.

So If you choose DNR/DNI at any time you do not need to worry about your caretakers abandoning you. They will take care of you all the way to the end. Just by following your wishes to let the natural process of dying occur, they are taking care of you and paying attention to your needs and wishes.