DNR help?!?!!

I work in a LTC/skilled rehab and as I was coming in for shift change, one of my patients (who had a DNR in place) was being sent out via 911 to the ER. Apparently during an activity, she became unresponsive, BP 70/50, lethargic, facial droop, etc.

Normally we do not send DNR patients out to the ER, but I am almost glad we did because I got a call two hours later saying that she had a massive heart attack and passed away. So if we hasn't sent her out, she would have passed away in the facility under my care, which is something I have yet to experience in my nursing career.

It makes me nervous to think about the first time someone is actively dying and me not being able to resuscitate them or help them.

My question to you all is, has anyone had such experiences?? Has a person who has a DNR ever asked you to help save them at the last moment? What did you do? How do you handle their final moments? If you knew a person was a DNR and they were in distress, what did you do until they passed??

I understand why DNR orders are placed and i do not disagree with them. However, I am not a very good "bystander", I like to jump in and help. It's hard to imagine any other way. Any advice/insight/stories would be helpful.
Always remember that "Do Not Resuscitate" does not equal "Do Not Treat." When I worked in LTC, we sent out residents regardless of DNR status unless there was an MD order specifically saying not to call 911. For example, suppose a DNR resident developed sepsis requiring treatment beyond what nursing home could provide. The resident will go to a hospital, get antibiotics and monitoring, and then come back in better health. If the resident deteriorates while in the hospital though, a code won't be called as the patient is DNR. If you encounter a resident who is DNR and actively dying -- which you definitely will -- there are plenty things you can do to "help." Patients are put on DNR status when they decide to focus on quality of life rather than prolongation of life due to their old age or terminal illness. Therefore, what we do for them as nurses will be mainly comfort measures, not heroics. Some examples of what you can do: Medicate for pain. Provide oxygen if they're short of breath. Keep them clean. Control secretions. Comfort them if they're scared/distressed. Keep them company if no one's there (who wants to die alone?)

DNR means, in my facility which is a rehab/LTC, I'm not going to hook them up to the AED, should they be found not breathing with no pulse. It has NOTHING to do with treatment before that point. I would do the same for them as I would for a patient that is full code. Hospice, however is another ball game. DNR does not mean hospice.DNR means do not resuscitate, NOT do not treat.

Quote from vaLPN757It makes me nervous to think about the first time someone is actively dying and me not being able to resuscitate them or help them. I understand why DNR orders are placed and i do not disagree with them. However, I am not a very good "bystander", I like to jump in and help. It's hard to imagine any other way. Any advice/insight/stories would be helpful.

Quote from laderalisDNR means, in my facility which is a rehab/LTC, I'm not going to hook them up to the AED, should they be found not breathing with no pulse.It has NOTHING to do with treatment before that point. I would do the same for them as I would for a patient that is full code. Hospice, however is another ball game. DNR does not mean hospice.DNR means do not resuscitate, NOT do not treat.

[FONT=verdana, arial, helvetica, sans-serif]I have only handled a few of these experiences, and it's hard on the heart sometimes. It sounds liek you have a lovely heart.I have never had a patient with a DNR ask me to save them at the last moment, that would be difficult! I don't even know what to do then - do you get someone to witness it and then proceed in saving?With final moments, I make them comfortable. If they have pain meds charted, I give them regularly. If they don't, I get them charted. I place oxygen on them in as non-invasive way as possible. And always, if possible, I sit by them and chat to them, or massage their hands with sorbelene if they are alone. No one should die alone. I also, if it will make the patient more comfortable and is not required, remove as much as possible. I also believe that even if a patient is unconscious, they can still hear, so I chat to them as much as possible as I do their care. Nursing when a patient is dying is at the heart of nursing I think, it's where we can truly show our love for what we do.