A Do-not Resuscitate (DNR) Case Study

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A Do-not Resuscitate (DNR) Case Study

Case Study Summary

In their day-to-day life, healthcare professionals are faced with difficult decisions meant to save their patients’ lives. The case is not different for nurse Anne, a registered nurse at a private hospital in California. Anne was going about her usual business at work when a patient was hurled in by an ambulance. The patient was Mrs. Harper, a 67-year-old woman ailing from stage four breast cancer. The elderly woman is accompanied by her only daughter, Sonia, who is in her early thirties. Sonia is in tears and desperately pleads with the doctors and nurses there to help save her mother’s life. A few moments ago, Anne had just walked in from work. She was living with her mother, who had recently moved from DC to stay with her daughter and her live-in nurse. A few weeks ago, she had had a conversation about a Do Not Resuscitate Order, also known as DNR. Sonia did not want to agree with her mother’s wishes. She could not believe that her mother was asking for her help in ending her life. Mrs. Harper had stage four cancer and was in great pain. For a terminal illness, the doctors had estimated that she had at most five months to live. She was on pain medication, and she had decided to end her chemotherapy treatment sessions. Mrs. Harper told her daughter that she wanted to die under her own terms and that she wanted her daughter to be the one to administer the drug that would put her to rest forever. This was a tough call for Sonia, who was yet to come to terms with the reality of the situation. Sonia had not given up on her mother’s life; she had, in fact, enrolled her for a trial treatment with a clinic in California, but her mother declined. Mrs. Harper told her daughter that the only reason she agreed to move in with her was that a DNR order was illegal in the state where she used to live.

So on this particular day, Sonia was at work when she received a disturbing phone call from her mother’s caregiver. The caregiver informed her that her mother had refused to take her medication. Sonia told her mother that she would leave work and come home if she continued refusing the medication. The caregiver told Sonia that in most cases, if patients refuse to take medication, it is usually a sign that they are ready to go. Mrs. Harper later promised her daughter that there was no need for her to leave work and that she would take her medication. Later that evening, when Sonia arrived home, she found her mother alone. Mrs. Harper had refused to take the medication and sent her caregiver home. Sonia was in distress. She could not believe that the time for her mother to go had come and that she would be the one to administer the drug that would kill her. She held her mother in her arms one last time, and they sobbed and talked for the last time. Eventually, she gathered the courage, mixed the prescribed drug in orange juice, and held it for her mother to drink. Mrs. Harper was unconscious in a matter of seconds. Sonia could not believe this was happening. She was not ready for her mother to die. She called for an ambulance that took her mother to the emergency room. On arriving, Mrs. Harper was received by Anne and a team of other doctors. When asked what her mother had taken, Sonia kept screaming that they should just save her life. Upon looking at her condition, the nurses realized that Mrs. Harper was in stage four cancer, and her doctor had signed her Do-Not-Resuscitate Order. Anne was confused about how to handle the situation, but she had to oblige to the patient’s will, which is a conflicting position for any person.

Effectiveness of Communication Approaches in the Case Study

The communication strategies employed in this scenario were effective but, at the same time, placed Anne and her team in a conflicting position. A DNR is a legally binding order that a doctor signs at a patient’s request (Kim & Keneally, 2021). It directs medical professionals not to resuscitate a patient if they stop breathing or go into cardiac arrest. In this case, although Sonia was well aware of the fact that her mother had a DNR, she was still in denial that she was about to lose her mother for good. At her mother’s request, she is the one who administered the drug that put her in that state. Upon arriving at the hospital, at first, she did not disclose that her mother had a DNR to the doctors. After looking through her records, they realized she was a stage four cancer patient. Mrs. Harper had lost her hair and seemed that she had gone through a lot of pain. At this point, they asked Sonia if her mother had a DNR, to which she admitted. At this point, the nurse told Sonia that they could not administer CPR treatment as it would be going against the patient’s order.

Effectiveness of the Approaches Used By the Healthcare Professional

Upon realizing that Mrs. Harper was a stage four cancer patient who had decided to end her life, Anne knew immediately that she could not perform CPR treatment or any other action that could help revive her patient. Anne handled the situation as any professional would. Once Mrs. Harper was brought in, she quickly assessed the patient’s position, and the first question she asked was if her mother had a DNR order. She quickly realized something was amiss since Sonia did not want to disclose the information about her mother’s DNR at first. Anne realized that when asked a question, her only response was that they should concentrate on saving her mother’s life since they were doctors. After admitting that her mother had a DNR, Anne took a moment and explained that she could not administer CPR as it would go against the order. As a health professional, Anne handled the situation the best way she could. She did not violate the healthcare principles and the wish of her patient.

Application of Ethical Principles to Possible Solution for the Problem

In this case, there is a possibility that the DNR order could have been deemed invalid, enabling Anne and her team to resuscitate Mrs. Harper. There are circumstances where doctors can resuscitate a patient with a DNR, such as if what caused the breathing was something that was not natural, like sudden airway blockage or trauma (Osinski, Vreugdenhil, de Koning, & van der Hoeven, 2017). Sonia did not tell the nurses that she was the one that induced the condition by giving her mother a prescribed drug. She knew that had she told the nurses the information, they could have performed CPR on her mother. Her mother was already going through so much pain, and it was her wish to rest, and Sonia had no option but to respect her wishes.

References

Kim, C., & Keneally, R. (2021). The Do Not Resuscitate (DNR) order in the perioperative setting: practical considerations. Current Opinion in Anesthesiology, 34(2), 141-144.

Osinski, A., Vreugdenhil, G., de Koning, J., & van der Hoeven, J. G. (2017). Do-not-resuscitate orders in cancer patients: a review of literature. Supportive Care in Cancer, 25(2), 677-685.