DNR orders have been implemented for more than 20 years. However, they sometimes fail to fulfill their purpose adequately. The main purpose of a DNR order is to support the autonomy of a patient and restrict the use of treatments that are not beneficial to a patient (Elo, 2017). Failure to implement the orders has serious outcomes, including legal consequences. Patients are denied a chance to have their wishes related to the issue, and CPR is conducted on patients who can be harmed by the procedure or simply do not want it (Elo, 2017). In the case study, the patient involved had issued directives of DNR, and it was indicated in his medical forms. However, the procedure was already in progress when the nurse realized that the patient had a DNR code. In addition, there was a conflict between the son and daughter over the DNR orders. This situation presents a miscommunication scenario. Although the son has a power of attorney, the patient’s autonomy, in this case, has to be respected. A power of attorney cannot override the DNR orders. The patient in this situation should have discussed the DNR orders with his son so that in case of such a scenario, the son was aware of his father’s wishes and understand what the DNR orders mean.
The responsibility of the family in such a situation is to respect the DNR orders and have directives executed. The son should have asked the necessary questions related to the directives for him to understand what the DNR orders mean in relation to his attorney’s powers. The nurse, in this case, had a crucial role to play. Nurses are patient advocates (Long, 2015). Therefore, they have an essential role in starting discussions on DNR with patients, their family members, and other health care team members. In this case, the nurse should have communicated with other health care members involved in the DNR status of the patient to prevent going against the directives. Nursing care should meet the comprehensive needs of both patients and their families across the care continuum (Long, 2015). In addition, they are a part of examining and ensuring that responsible and proper interventions are used to reduce undesired or unwarranted interventions and the suffering of their patients. Therefore, the nurse, in this case, had to communicate with the son too on respecting the patient’s autonomy based on the DNR orders hence stop CPR. However, legal implications are inherent in such a case because the daughter can press charges for going against the CPR orders.
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I recently observed a miscommunication scenario that resulted in the death of a patient due to sepsis and a ruptured cerebral artery. The true situation of the patient involved was not communicated adequately, and the nursing staff did not understand issues related to after-hours accessibility and the cost of interventions present in the emergency unit. There was poor communication, both verbally and the documented information. The environment that was characterized by a lack of mutual interaction and values may have contributed to the miscommunication. Communication requires the people involved to have a mutual interaction and the recipient giving feedback to the sender (Bylund, 2015).
In both the case study and recent interaction, I would mentor my staff on effective interpersonal communication/skills, use of bedside boards, maintain eye contact during a shift change, and giving patients full attention to ensure that everything is done appropriately and correct interventions administered. In each of the two situations, I would initiate a discussion on the events with the team members involved. In the discussions, the aim would be to discuss the actions implemented and the thought processes that were implemented. The teams would then be encouraged to make a reflection of the actions, decisions, and though processes implemented and provide ways in which such situations can be improved to prevent repeating the same mistakes in the future.
References
Bylund, C. L. (2015). Communication skills training for healthcare providers. The International Encyclopedia of Interpersonal Communication , 1-8. https://doi.org/10.1002/9781118540190.wbeic250
Élő, G. (2017). Autonomy: Patient-centered decision making regarding cardiopulmonary resuscitation (CPR). https://doi.org/10.26226/morressier.58f5b02fd462b80296c9e31d
Long, B. (2015). What would Florence do? Nurses, as patient advocates. Nurse Leader , 13 (1), 37-47. https://doi.org/10.1016/j.mnl.2014.11.004
