Doctors in New Zealand usually discuss do not resuscitate (DNR) orders with families, however, nurses in the United Kingdom have complained this has not been happening there.
An article published in The Telegraph outlined a worrying trend being uncovered by nurses who have found incidents of patients having DNR orders without their family’s knowledge.
Massey University professor of Nursing and executive director of the College of Nurses, Jenny Carryer, said it was best practice in New Zealand for DNR orders to only be placed after discussions with patients and their family.
“I’ve seen it in practice and this would happen in the majority of cases.”
There would only be the occasional time that families were not consulted but there would usually be a good reason, she said.
Nurses are very comfortable with DNR orders and know when they are recommended.
They are the people who are with patients and their families 24/7 so they would know if a patient had one without their loved ones’ knowledge, she said.
If this did happen then the nurse would usually speak with medical staff and the family in order for discussions to be made to rectify this.
“I think generally nurses can be pretty confident with DNR orders.
“They are made when somebody’s quality of life doesn’t warrant excessive measures to keep them alive and there is a move to palliative care.”
The Health and Disability Commissioner states that if a patient was competent at the time a DNR order was made there is no obligation to consult with family about its contents.
“The views of family members about any type of valid advance directive are not binding.”
The article in The Telegraph said nurses in the UK often found themselves in situations where families were shocked to learn their loved ones had DNR orders.
One nurse had visited her great aunt and found out she had agreed to a DNR order after being told while “alone and vulnerable” there was no point in further treatment.
Other nurses said patients and families also needed to be made aware of the realities of chest compressions which can cause considerable damage to an already unwell person.
The Royal College of Nursing will be considering proposals on whether further training and support should be provided to nurses on talking to families about DNR orders.
The New Zealand Nurses Organisation directs that best practice is for organisations that employ nurses to have policies relating to resuscitation orders and nurses must be familiar with these policies.
Its position statement on end-of-life care said nurses must be aware DNR can have different meanings to people from differing cultures and extra time may be needed to support these people and their family facing DNR decisions.
A DNR order is legally binding and instructs medical staff not to resuscitate a patient if they become unconscious.