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NOTUrses have warned that too many hospitalized patients are subject to a resuscitation ban without their relatives being informed, one of them describing having found her own aunt in such circumstances.
The Royal College of Nursing yesterday heard repeated warnings that "communication failures" meant families were shocked to discover that such decisions had been made about their loved ones.
Do not attempt resuscitation (DNAR) orders medical personnel not to resuscitate a patient if he loses consciousness.
The constitution of the NHS in England states that patients and their families have the right to participate in discussions about the advisability of making such orders.
Speaking at the Royal College of Nursing congress in Liverpool, nurses said they had repeatedly met with cases in which families had been shocked to learn that such decisions had been made.
Nurse Joanne Day reported that she had visited her great aunt – who was a patient at the hospital where she worked – at the end of a night shift, to find out that the doctors had made an order from the ARNE on his notes.
The nurse told her parent, who had acute kidney failure, that it was useless to continue treatment when she was "alone and vulnerable" late at night.
"They waited until she was alone very late at night, very fragile and very vulnerable to tell her that she would not respond to treatment and that they were setting up a DNAR …." She was not discussed with any of the family members, "said Ms. Day, who discovered her only because she had visited her great-aunt at the end of her shift.
Hamish Kemp stated that he had been summoned by a disgruntled man whose brother had received an order from ARNE without anyone being consulted.
The nurse stated that she had "made several urgent phone calls" and managed to cancel the order, adding, "It is not true that we should have a system whereby a person decides to act as such."
The nurses said that doctors should ask each hospitalized patient if he wished to be resuscitated, if the situation arose, they said.
Having "open and honest" conversations with patients and their families as soon as possible would mean they would have time to make informed choices, they said.
Fallon Scaife, a palliative care nurse from Manchester, told Congress: "I've seen many times that these discussions did not take place early enough with patients and their families, and that patients did not control what they arrived.
"They end up with limited options regarding their place of care, they are scared and the stigma surrounding death, they often feel out of control."
Other nurses said that patients and their families should also be informed of the reality of chest compressions – which can cause injuries such as broken ribs and bleeding – and warn them that it did not look like television .
Justin Woolford, emergency nurse, said, "We should allow [patients] to make an informed decision and not based on the glorified resuscitation attempts they see on television, on the hearsay of others, or on the misconception that DNAR is equivalent to no treatment – and we should respect their wishes. "
Resuscitator Ged Swinton said he was involved in caring for a 94-year-old woman who was dying of cancer. The doctors were too scared to give him an order from the DNAR "in case the family would be prosecuted," but the nurses of the ward were afraid to revive her.
"They told me," She is dying and we do not want to have to jump on her chest and cause her stress and an unworthy end. "
Mr. Swinton spoke to his parents and his doctors, who agreed that it was best not to resuscitate. The woman died with her family at her side. "Calmly, in a good bed, calm, clean and dignified," he said.
The union will now review the proposals as to whether additional training and support should be provided to nurses to talk to families about ARNE orders.
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