Health Sentinel: Care Providers Change Language of Death | the News-Sentinel - Fort Way
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Health Sentinel: Care providers change language of death | The News-Sentinel - Fort Way... Page 1 of 2 Subscriber Services News-Sentinel Mostly Cloudy Fort Wayne Magazine Vacation Requests 74 °F Search: Go August 18, 2009 - 10:37 a.m. Welcome Guest. Login | Register | Member Benefits Jobs Cars Real Estate Apartments Classifieds Shopping Celebrations Obituaries News-Sentinel Home News Neighbors Life Events National International Posted on Mon. Apr. 27, 2009 - 12:01 am EDT E-mail this story Print this Send a news tip Submit a Rant Sports Komets HEALTH SENTINEL PrepSports Scores & Stats Health Sentinel: Care providers change language of death National Business Term “allow natural death” helps families embrace process. Editorials Features by Jennifer Boen Entertainment Death is a given. It can perhaps be delayed but never TV Listings avoided. Movie Show Times Celebrations Embracing death as a natural process is at the core of a Obituaries change in terminology coming to the forefront of hospitals, Projects hospice providers and nursing homes. Photos Submit Photos For years, do not resuscitate, or DNR, has been the Buy Photos designation for not prolonging life when a person's heart NS Staff stops beating or breathing stops. A new designation, allow Contact Us natural death, or AND, is becoming the preferred term among some entities, including several hospitals within RSS Lutheran Health Network. Bookmark this Site Archive Proponents of the AND designation say it creates for patients and medical staff a more positive approach. It is about what is allowed to occur as opposed to what is not to be done. “We started looking at this concept about a year ago,” said Sister Carole Langhauser, vice president of Mission Jobs Integration at St. Joseph Hospital. St. Joseph and Dupont Hospitals are now using AND instead of DNR. Lutheran Cars Hospital is transitioning to AND usage. Real Estate “It's more than just semantics. It's more a philosophy of looking at death and dying,” Langhauser said. “Life is a Apartments continuum. This is making dying as positive as being born. What a wonderful gift that is.” Local Shopping All Classifieds Legally, DNR orders mean do not treat. But the hesitancy for some people when asked if they or their loved one wants to be designated DNR is the implication that “no treatment” is synonymous with “no care.” That is not the case, Langhauser said. Lottery “The whole idea of health care and medicine is to cure the patient,” she said. “There comes a time when cure isn't Weather possible … then it's more caring than curing.” Many comfort measures can be included in that “caring” list. Subscribe Vacation stops My father, who had leukemia, multiple sclerosis and Parkinson's disease, had chosen the DNR designation before his Subscription & death in 1999. It sounded cold, as if he might lie in bed, suffering until the end. That was not the case. He was tended delivery issues to by a nurse throughout the dying process, given a mild pain medicine and even oxygen. But when he took that last breath as I sat by his bedside, no one questioned that CPR was not to be given. Without advanced directives, a misunderstanding can lead medical staff to act in a way incongruent with the patient's wishes or what the family thinks should be done. Does the patient still want blood tests or antibiotics? What level of pain medication is desired? Are intravenous fluids to be given? In a study published in 2008 in the Journal of Medical Ethics, researchers compared how three groups of people — STOCK SUMMARY nurses, nursing students and family members — evaluated the meanings of DNR and whether changing the language Dow 9213.18 +77.84 to AND would increase endorsement and compliance of the order. Nasdaq 1954.41 +23.57 S&P 500 989.04 +9.31 The nurse groups overwhelmingly were supportive of the “do not treat” order as requested by the patient, regardless AEP 30.7501 -0.1399 of DNR or AND language. But the family members had the greatest hesitancy with DNR language. Using “allow Comcast 14.43 -0.13 natural death” increased the probability all three groups would endorse and abide by the order. GE 13.5805 +0.2205 GM 0.00 N/A Langhauser said physicians are embracing AND over DNR. A 2004 Hastings Center Report compared real-life ITT CORP 48.66 +0.39 accounts of two families dealing with end-of-life decisions. The family that was offered the option of signing DNR for a LNC 23.04 +0.82 loved one in the event of cardiac arrest became upset and agitated. Another family facing the same dilemma but who Navistar 43.90 +1.39 was given the “allow natural death” option reported a better understanding of the option and the fact their loved one Raytheon 47.20 +0.07 would be appropriately cared for. SDI 16.20 +0.56 Verizon 30.215 -0.005 Parkview Health officials say it is that discussion — the explanation of options that takes place between the doctor and the family or patient — that is the most critical element, not the language. Although Parkview staff members have dialogued about AND vs. DNR, Parkview Health is keeping with DNR because it is consistent with state statute and “it is the language that our patients and staff know and understand,” said http://www.news-sentinel.com/apps/pbcs.dll/article?AID=/20090427/LIVING/904270307 8/18/2009 Health Sentinel: Care providers change language of death | The News-Sentinel - Fort Way... Page 2 of 2 Catherine Wilcox, senior vice president and general counsel for Parkview Health. “When we're talking about do not resuscitate, we're having a full conversation,” a conversation that hopefully has taken place prior to when death is imminent, said Judy Boerger, chief nursing officer for Parkview Health. That is why hospitals are required by law to ask if a patient has a living will (one form of advance directive) at the time of admission and at the time of treatment. “We don't use DNR at the bedside when we have that conversation,” she said. Stock Sponsor Yet Boerger concurs, “There's a point that ‘do not resuscitate' is a harsher sound.” But the concern, she and Wilcox say, is that DNR is the known term and the acceptable one under state law. “You can express yourself in compassionate ways, but what you write on your chart at Parkview is DNR,” Wilcox said. Accountants At St. Joseph Hospital, the written policy states AND can stand for DNR, Langhauser said. Mannia Green & Co. Discussion on DNR vs. AND has just begun at Fort Wayne's only free-standing hospice facility. Body And Fram Person; Painter “We are looking at how to incorporate AND into our terminology,” said Andy Candor, president and CEO of Visiting Indana Auto Auction Nurse and Hospice Home of Northeast Indiana. The “allow natural death” aligns wholly with the hospice philosophy, Candor said. Student Life, Americorps Program “As more and more institutions look at this, they will realize it's so much easier for the whole health care team to Assistant approach patients and families,” Langhauser said about using AND. “We've always talked about death with dignity. Ball State University The ‘allow natural death' policy draws that all together.” Jennifer L. Boen covers health and social services for The News-Sentinel. She can be reached at 461-8416 or by e- View more jobs... mailing [email protected]. This column is the personal opinion of the writer and does not necessarily reflect the views or opinion of The News-Sentinel. © 2009 - The News-Sentinel, all rights reserved http://www.news-sentinel.com/apps/pbcs.dll/article?AID=/20090427/LIVING/904270307 8/18/2009.