The over-interpretation of DNAR

Title

The over-interpretation of DNAR

Creator

Stewart M; Baldry C

Publisher

Clinical Governance

Date

2011

Subject

Medical Sciences; Studies; Emergency medical care; Business And Economics--Management; Duty of care; Patients rights; Right to Die

Description

The purpose of this paper is to investigate the impact of a Do Not Attempt Resuscitation (DNAR) order on subsequent decision making relating to the clinical care of the patient. The approach taken was a questionnaire based on a hypothetical clinical case, completed by medical and nursing staff of all grades in general medical, surgical, and orthopaedic wards. There is a reduction in the urgency attached to reviewing a deteriorating patient following institution of a DNAR order. Many doctors and nurses will not perform a range of interventions in the patient with a DNAR order in place. Confusion exists regarding whether an apnoeic, peri-arrest patient should be ventilated when a DNAR order is in place. This was a single-centre study, looking at a hypothetical situation. Further studies at more centres, and investigating different designs of DNAR form, would clarify the best format for these to take. A DNAR statement may often be interpreted as limiting other forms of care. This is more likely amongst more junior doctors and nursing staff, who are frequently the first line of assessment of these patients. More explicit DNAR forms may be advisable to confirm what treatments are to be continued. This paper demonstrates that DNAR decisions are taken as a surrogate marker for limiting other forms of care, and that this extends to medical and nursing staff at all grades.

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation

Stewart M; Baldry C, “The over-interpretation of DNAR,” Pediatric Palliative Care Library, accessed November 27, 2021, https://pedpalascnetlibrary.omeka.net/items/show/11513.

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