The meaning of DNR status: oncology nurses' experiences with patients and families

Patients, providers, and families are increasingly involved in end-of-life decisions (advance directives, health care proxy, do-not-resuscitate [DNR] status consents). These decisions can be complex processes whereby the participants in the process must come to terms with often painful and difficult decisions. The role perception of the nurse in end-of-life decision making is not well delineated. This chapter explores the results of a study that addresses the question, "What are the experiences of oncology nurses as they interact with patients and/or family members during the process of patients/families signing DNR consents. The grounded theory method of data collection and analysis was used to explore this question. The results of the study indicate that central to the process of consenting to DNR status is the degree of shared understanding about the meaning of DNR status among participants and the conflict that can occur when meanings are not shared. A model is presented that illustrates the connections between the meanings of DNR (patient, family, and provider) and congruence and conflict in the DNR consent process. Strategies are discussed that facilitate prevention or resolution of conflict in the DNR status decision-making process. Strategies used by the nurse to facilitate decision making by patient and families include communicating with, caring for, educating, advocating for, and collaborating with patients, families, and other providers.