Do Not Ressucite a Different Caring

Do not resuscitate: A different caring As stated by Fields, “Do not resuscitate does not mean no care; it means a different kind of care that can be best achieved through end-of-life protocols and education” (2007, p. 294). According to Lachman (2010), do- not-resuscitate orders, or DNRs, are not being initiated early enough in their hospital stay for identified terminal patients. The purpose of this paper is to investigate and focus on a few reasons why this is happening, as well as to provide a few solutions. The terminal patients are the patients with chronic diseases such as end-stage renal disease, congestive heart failure, and diabetes, who have had an exacerbation in their symptoms which has now rendered them terminal. Prognostic tools and evidence-based predictor tools are being implemented more frequently to define these critical, “terminal” patients (Papadimos, 2011). These tools are especially important, because they apply mainly to non-cancer patients, whose terminal prognoses often overlooked. DNRs are not being initiated earlier in the hospital due to barriers such as the semantics of a DNR, doctors not setting the time to have the conversation with the family early enough in the hospital stay, and the miscommunication between healthcare providers, patients, and family members. The first advance directive, called a living will, was proposed by the Euthanasia Society of America in 1967 (Glick, 1991). On December 1st 1991, the Patient Self Determination Act (PSDA) came into effect (Glick, 1991). This is a federal law that requires all hospitals, nursing facilities, home health agencies, home health care providers, and hospices to provide patients with written information about advance directives (Glick, 1991). As Glick (1991) states, the PSDA was an amendment to federal Medicare and Medicaid laws, with the idea that it would impact how people plan for their future healthcare. Glick emphasizes that he PSDA acts as an information and education

References: Cybulski, P. (2011). A critical care nurse 's role in the provision of end-of-life care. Dynamics, 22(4), 7+. Retrieved from http://go.galegroup.com.db16.linccweb.org/ps/i.do?id=GALE%7CA275313154&v=2.1&u=lincclin_mdcc&it=r&p=AONE&sw=w Evans, N Lachman, V. (2010). Do-not-resuscitate orders; nurse’s role requires moral courage. MedSurg Nursing, 19, 249. Retrieved from http://go.galegroup.com.db16.linccweb.org/ps/i.do?id=G ALE%7CA236162685&v=2.1&u=lincclin_mdcc&it=r&p=AONE&sw=w Lachman, V. D. (2011). Nurse 's role in increasing patient access to hospice care. MedSurg Nursing, 20(4), 200+. Retrieved from http://go.galegroup.com.db16.linccweb.org/ps/i.do?id=GALE%7CA264270663&v=2.1&u=lincclin_mdcc&it=r&p=AONE&sw=w Papadimos, T Sullivan, A., Lakoma, M., & Block, S. (2003, 09). The status of medical education in end-of-life care. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494921/ Tulsky, J., Chesney, M., & Lo, B Yeon, J., Reid, M., & Fetters, M. (2011). Hospital do-not-resuscitate orders: why they have failed and how to fix them. Journal of General Internal Medicine, 26(7), 791–797. doi: 10.1007/s11606-011-1632-x Zingmond, D.S., & Wenger, N