Do Not Resuscitate (DNR) Decision: Who Makes It? (Disturbing Research, Video 4:16)

Who really decides not to restart the heart during a cardiac arrest situation? Many patients may not realize that the decision is a complex one involving nurses and physicians with a wide variety of their own personal experiences and perspectives about how the situation should be handled. Previous studies have shown different perceptions of the DNR decision process among nurses and physicians concerning patient involvement and information. In addition, decision-making has been reported to be unclear with inconsistent documentation.

A researched web research study on DNR decision making including 132 nurses and 84 physicians reported the following results:

1) Almost half of the respondents reported it not likely that the patient would be involved in the decision on DNR.

2) Twenty-one percent found it unimportant to inform patients of the DNR decision.

3) Fifty-seven percent reported that providing information to the patient was important, but only twenty-one percent stated that this was likely to happen.

4) Attributes deemed most important for both nurses and physicians pertained more to medical viewpoints than to ethical values.

5) Nurses chose patient autonomy as the most important value, while physicians rated non-maleficence (no harm) as the most important value in relation to DNR decisions.

This research is very disturbing and clearly shows the need for more and better interventions to ensure patients' values and preferences are addressed and integrated into end-of-life decisions. The importance of patients having Advance Directives done detailing their healthcare wishes and selecting surrogates who will truly advocate for them can’t be emphasized enough.

Nurses and physicians need to be able to talk openly about their different perspectives on DNR decisions, so they can develop a deeper understanding of the decisions, especially in cases where they disagree. The organization needs to support such discussions through providing an environment that allows ethical discussions on a regular basis. Patients and relatives will also benefit from receiving the same information from all caregivers.

In recent years, wearing a tattoo stating “Do Not Resuscitate” has become more popular as a way to safeguard one’s healthcare rights regarding this topic. Should a tattoo of an incapacitated patient be honored? Art Caplan, head of the Division of Medical Ethics at the NYU School of Medicine discusses such a case in this video:

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Hospice and Nursing Homes Blog

Older Adult Senior Bullying: No Home Sweet Home (Research, Solutions)

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By Frances Shani Parker

When you think of the words “home sweet home,” what kind of thoughts do you envision? Do you smile and recall experiences you associate with sweetness such as love, support, and peace? Are you mindful of the physical, mental, spiritual, and social benefits you receive that improve your quality of life and health in a caring environment? Unfortunately, if you are an older adult living in a senior community and experiencing peer bullying, the sweetness of home may be missing. In addition, your likelihood of social isolation, depression, disease risk factors, and decreased mortality are threatened.

An older adult senior bullying research study was done to identify the nature, prevalence, and consequences of peer bullying for tenants of two low-income senior apartment communities. In collaboration with the local Older Adult Abuse Task Force, a screening survey on bullying was distributed to all tenants. Results of the surveys indicated that 39% of tenants had witnessed peer bullying and 29% had been subjected to bullying by peers. “The most common forms of peer bullying were deliberate social exclusion and hurtful comments. The majority of respondents indicated that bullying was a problem for seniors and that bullies hurt other people. Outcomes of bullying included feelings of dejection and difficulties conducting everyday activities.”

Currently, one out of five seniors is bullied by peers. This is worse than the one out of seven rate for young people. Due to underreporting of incidents, the numbers of bullying confrontations are often much higher than suspected. That's why only addressing sporadic incidents without the context of a larger anti-bullying plan frequently fails. While the above research results indicate the most common forms of bullying, there have been many other more serious cases that have included legal action, physical violence, and suicides.

Bullying occurs within all socioeconomic groups and anywhere in a senior facility. A common bullying violation is seats being saved for latecomers while people who have already arrived are denied seating. This is in violation of the first come, first served order of seating and happens often in dining areas and recreational spaces such as movie theaters. Sometimes seniors are selfish and very rude to peers who are different in some way such as newness, appearance, race, ethnicity, sexual orientation, economic status, or a disability. Unfortunately, too many victims suffer in silence at their own detriment by avoiding perpetrators and not reporting bullying incidents to administrators, especially when previous reporting has not helped on a large scale. Concerned about personal negative repercussions, bystanders often do little or nothing to support victims. Fear runs deeply, but reports from victims and witnesses are greatly needed to solve bullying problems.

It is imperative that administrators of senior facilities implement ongoing solutions to bullying issues. Some are in denial about the magnitude of the problems and resist giving bullying concerns their full attention. Some are aware of problems, but don't want others, especially visitors or potential customers, to know bullying problems exist at their locations. The Internet, senior organizations (such as AARP), publications, and other resources are available to provide a great deal of helpful information. Bullying problems must be approached methodically with research, needs assessments, concrete plans, staff and resident training, implementation of solutions, and ongoing monitoring. A formal anti-bullying policy should be created and included in a handbook, so everyone shares a common goal and reference.

An anti-bullying culture must be established that reminds bullies they are not in charge and will be dealt with appropriately. A culture is not established through private conversations with a handful of violators or infrequent comments to large audiences. Victims need this culture for ongoing reassurances that they will be supported when they defend themselves against bullies. Residents need access to an ongoing dependable procedure for reporting bullying incidents that will be addressed in a timely manner. Posted anti-bullying signs (No Saving Seats, Bully-Free Zone) provide visibility of an anti-bullying culture. Ignoring bullying is done at the expense of residents' quality of life and impaired health. Confronting bullying head-on includes consistency in solution implementation and respect for everyone’s dignity and rights.

Note: You can view information below that includes more bullying research (long-term care staff perspectives), descriptions of older adult senior bullying incidents, legalities, comments, a video, and a link to AARP training and policies:

1) Bullying in Older Adult Senior Communities (Research, Video 2:49)

2) AARP - Bullying in Older - Adult Communities


Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
Hospice and Nursing Homes Blog

Centenarian Health (Research, Birthday Video 2:20)

How many centenarians, people living at least 100 years, do you know? This population is growing so fast, it is not unusual these days to know several. In fact, if you haven't already, many of you reading this post may become centenarians yourselves. Reaching this formerly rare milestone has become common nowadays, not only because of genetics, but also due to advances in healthcare with people living longer.

Those are not the only factors that impact how long people live. Surprisingly, marriage and living arrangements also play important roles. Being a centenarians living with a spouse during old age is more beneficial in terms of longevity for men than for women. For women, living alone is more advantageous than living with a spouse. Generally, men are often not able to live well by themselves, whereas women seem to have fewer problems living on their own.

Recent research findings by the Georgia Centenarian Study focused on the relationship between vision impairment and well-being among centenarians. This study evaluated their visual function and assessed the relationship between vision, social support, and well-being. Centenarians reported lower levels of depression when they had social support. However, centenarians who had low levels of visual function tended to report higher depression even if they had social support. Results of this study indicate that vision function is related to centenarians' well-being, especially depression.

Speaking of centenarians, imagine the possibility of 20 living in one residence. A residence in Cote-St-Luc in Canada celebrated several centenarians in a group birthday party, leaving them with a total of 20 residents over 100 years old.

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Hospice and Nursing Homes Blog

Dementia Caregiving Benefits (Alzheimer’s Research, Video 4:44)

Caregiving in general has positive and negative aspects, and dementia caregiving is no exception. Dementia refers to a group of conditions that gradually destroy brain cells and lead to mental decline. Many conditions can cause dementia, but Alzheimer’s disease is the leading cause. Those living with dementia may experience changes in behavior and personality, such as anxiety and delusions.  Like a fluttering bee, dementia can leave a caregiver wondering when it will make honey or sting.

It is helpful for caregivers to be reminded of the “honey” they can achieve in their caregiving roles, especially from the perspectives of primary caregivers of relatives. This research done with 57 primary caregivers of people living with dementia does that. These caregivers provided 669 diary recordings over an 8-week period. They described daily events and experiences in which positive gains in the form of themes were achieved. These were the positive themes they shared:

1)   Insights about dementia and acceptance of the condition

2)   A sense of purpose and commitment to the caregiving role

3)   Feelings of gratification when the care-recipient was functioning relatively well

4)   Skills to handle the care-recipient

5)   Increased patience and tolerance

6)   Positive meanings and humor amidst difficult circumstances

7)   Release of plans, such as an unrealistic personal agenda

8)   A closer relationship with the care-recipient

9)   Support and feelings of usefulness helping other caregivers

While negative outcomes for caregivers, such as depression, also need to be treated, drawing more awareness to these positive caregiver benefits and strategies to achieve them can be very rewarding. Knowing how to reframe stressful situations in a more positive light can add more positivity to caregiving experiences.

The following video titled “It’s a Sparrow” is a soul stirring example of how a negative caregiving experience can evolve into a positive one through thoughtful reflection.

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
Hospice and Nursing Homes Blog