Do Not Resuscitate Policies

Abstract

To the Editor.—Recently I completed a literature search on Do Not Resuscitate policies in home care agencies in the United States. During that search I read with interest an article that appeared in the January 1989 edition of the Journal of the American Geriatrics Society. The article, “Do Not Resuscitate Discussions in a Hospital-Based Home Care Program” by Havlir et al, makes many good points about the need for discussion of DNR options with home care clients. I would, however, like to recommend that the authors consider that home care nurses, as well as physicians, are appropriate professionals to initiate such discussions. Nurses are the health professionals who have the most frequent contact with patients and families in home care. They are well equipped to assess the psychosocial and emotional needs of patients and families. Nurses are skilled at helping patients and families set realistic goals for home care. If only physicians initiate such discussions with home care clients, many patients will be effectively denied access to the opportunity to consider this option since few physicians make home visits, and the vast majority of home care patients are effectively homebound. In agencies that have a policy that discussions of DNR options can be initiated either by home care nurses, patients, family members, or physicians, good results have been reported when nurses initiate such discussions.1