End-of-life care is not an obvious focus of the nursing home industry. With more residents being cared for in these facilities rather than transferring to the hospital or to a hospice, end-of-life care has become more common in the nursing home environment. There is a need to bring more clarity to end-of-life decisions for the residents and those with decision making rights. Lachman (2010) states that “family members often misconstrue do not resuscitate (DNR) as giving permission to terminate an individual’s life” (p. 251). Our facility identified the need to provide further education to demystifying what DNR really means. Our stakeholders are the residents, families, employees, medical teams and the area Hospice agencies. The scope is to enhance the knowledge of the resident and those with decision making rights to establish an individualized plan of care reflective of the end-of-life care choices.
In today’s healthcare environment, current practice is based on evidence, so early consideration of how evaluation will be done is imperative (Bastable, 2008, p. 558). Evaluation is an ongoing process that addresses the effectiveness of a specific intervention in a particular situation with an individual or specified group (Bastable, 2008, p. 558). Results of these evaluations then become a source to guide future practice when critically analyzed to enhance future nurse-patient interactions (Bastable, 2008, p. 559). End of life decisions are being made daily without the benefit of a discussion as to resident choices along with the documents to support these decisions (Later & King, 2007). As we learned, research indicates that many postpone the discussion of end of life care preferences and completion of the advance directives to the point where another has to make the decision (Later & King, 2007). Another is that twenty-five percent of deaths over the age of 65 occur in nursing homes (Hanson, Henderson & Menon, 2002). Demystifying what do not resuscitate (DNR)...
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