MANAGING CARE( continued)
Resuscitation Orders
In the event that one’ s heart ceases to beat or is in a life-threatening abnormal rhythm, an individual has the right to choose what, if any, type of resuscitative intervention they would accept.
Do Not Resuscitate( DNR), also called Do Not Attempt Resuscitation( DNAR) and Allow Natural Death( AND) Do Not Resuscitate orders are doctor’ s orders instructing medical personnel, nursing, and hospital staff not to try to return your heart to a normal rhythm by any means: cardiopulmonary resuscitation( CPR), electric shocks( defibrillation), or medications. On the other hand, a doctor may specify in writing the specific means by which you would or would not want to be revived. In addition, Do Not Resuscitate orders mean that you refuse life-support measures.
These orders require the patient’ s consent and signature, two witnesses, a physician’ s written order and signature, and inclusion in the patient’ s medical record. If a hospitalized patient does not want CPR under any circumstances, the physician is obligated to write the DNR order, thereby permitting nursing staff and code teams to withhold CPR. In out-of-hospital situations, such as at one’ s home or in a dedicated hospice facility, many states require a specific out-of-hospital form to be completed and signed by the patient or patient’ s proxy and the physician.
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Do Not Intubate( DNI) Do Not Intubate orders instruct medical personnel of a nursing facility or hospital that the patient does not want to be put on a ventilator, or breathing machine, to prolong their life.
Living Will
A Living Will allows one to put into writing their wishes about future medical treatment should one have a terminal condition( incurable, irreversible, and where death is imminent) and be unable to communicate. The Living Will outlines one’ s desire to withhold“ heroic measures.” It usually addresses resuscitation and life support; however, it may cover more preferences and interventions. For example, Living Wills can specify directions about particular death-delaying procedures one wants or does not want, such as artificial life support, transfusions, and dialysis. The key points to remember about Living Wills are: 1) They refer to a terminal condition; 2) They do not designate a patient’ s spokesperson or proxy.