Do Not Resuscitate.
Let’s get talking about DNR’s. It’s an important document that you may have many questions on.
DNR or DNACPR: Which means Do not attempt cardiopulmonary resuscitation (DNACPR).
I’ll use the term DNR in this post because that’s what most people are familiar with.
Breaking that down further it means that if your heart or breathing stops your healthcare team (including paramedics) will not try to restart it.
A DNR decision is made by you and/or your doctor or healthcare team and is used to protect people from being given inappropriate CPR and to respect their wishes.
So, who is a DNR for?
There are many reasons why a person might have a recorded DNR decision.
This from Resus,org –
“Some people choose to have one simply because they do not want to be resuscitated in an emergency. They might have a personal reason to make this decision, but this varies depending on the individual.
Others make the decision along with their health care provider, after experiencing health issues that might inform their decision.
There are also occasions when healthcare teams may have to make decisions on behalf of patients. In this case, they would try to involve patients or their loved ones wherever possible. This might happen because a patient is so unwell from an underlying illness, that CPR will not prevent their death. By making the decision on behalf of the patient, there is an opportunity for the patient to have a peaceful, dignified death.
A DNR only specifies whether a person will receive CPR or not. Patients will still receive appropriate treatment for their health issues and all personal care needs will be attended to.”
A DNR is usually recorded on a special form. It is kept on your medical file and you will usually have the original copy with you at home, in your care home or hospice. Different doctors and hospitals may use different forms to record your DNR wishes so it’s important that a copy of yours is on your medical records and that you take it with you when admitted to hospital and keep it in an accessible place, where someone other than you knows where it is when at home.
So, who complete and put in place a DNR?
Anyone.
Despite popular myth that only those with serious or life limiting illness being allowed to put a DNR in place EVERYONE who has capacity can do so. I have known some GP’s to refuse to put them in place for healthy adults but you have every right to do so should you wish either ask again stating the facts or opt to see another GP.
You can change your mind about your DNR at any time but you must inform your healthcare providers. What may have felt right for you one day might not feel right for you another.
Three very important points here –
1. If you want to make your DNR wishes legally binding then put in place your Advance Decision (ADRT which I’ll talk about soon)
2. Tell your people that you have put a DNR in place. If you don’t tell them how can they possibly advocate for you!
3. I cannot emphasise this one enough – Let your next of kin, your people, your carers know EXACTLY where to find your DNR. Without it physically present your wish for refusal of CPR will be ignored or dismissed. Let’s say you collapse and an ambulance is called, without seeing that DNR, the paramedics are obliged to perform CPR. They will not have access to your medical records. And yes, you even need to take it to the hospital with you so they have a copy of it too. I advise people with a DNR to keep it in an “In Case of Emergency” (ICE) folder, somewhere easily accessible and let your people know exactly where it is. A specified letter rack or something similar by their front door (on the inside , of course) can be helpful. It is absolutely devastating for people caring for you and not able to produce your DNR on request and watch helplessly as CPR is performed. And that absolutely does happen. So, put it somewhere easily accessible and tell your people where to find it.
As a doula it is not part of my role to help you complete a DNR registration – that is between you and your GP, hospital consultant or hospice team but I can accompany you during the process.
There, I think that’s covered the most important aspects of a DNR but let me know if you have any more questions or if I’ve missed anything.
With love
Nancy xx
HELD 