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DNR, "do not resuscitate".

Certainly a controversial subject. More than half of nursing home residents have DNR instructions in theur files, according to a CDC survey.

As aides or family members, we are advocates for the client, and for the best care possible. I am naturally suspicious of DNR's because I don't want an excuse for anything but the best safety measures and care.

The argument for DNR's is frequently that they may be appropriate where the act of resuscitation is likely to be painful or unreasonably traumatic for what will be a poor outcome anyway. For example, a terminally ill patient might want to pass away peacefully rather than have his last experience be a powerful and painful shock in a hopeless attempt at revival. Subsequent 'quality of life' issues are sometimes mentioned as reasons, too.

But actual end of life situations are often complicated. For example, if a client or family member on a respirator and with a weak heart is suddenly suffocating, you would want fast action to enable breathing. However, it might not be appropriate to try to shock his heart into beating again if it came to that. DNR instructions should be specific and appropriate. If you are considering one, be very careful and very specific. Don't let a DNR be an 'out' for anyone responsible for care.

From a CNA/HHA point of view, and for that matter, for anyone but the physician, a DNR instruction should make no difference in the level of care. Actually, that's not quite correct. Caregivers should be more vigilant than ever when there is a DNR instruction, because a DNR could very well mean that the caregiver is the last line of a client's (or loved one's) defense for their life.

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