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Nursing Care and Do Not Resuscitate (DNR) and Allow Natural Death (AND) Decisions

ANA Position Statement
Revised: March 12, 2012

Difficulties and confusion about do not resuscitate (DNR) orders still exist, despite efforts to help patients, families, and surrogate decision-makers make informed choices. This statement presents the current literature on barriers that interfere with nurses assisting patients in understanding goals of care and making the decision to have DNR orders written. This statement also makes recommendations for change in the clinical and organizational policy arenas.

Statement of ANA Position
Nurses must advocate for and play an active role in initiating discussions about DNR with patients, families, and members of the health care team. Provision 1.3 of the ANA Code of Ethics for Nurses (2001) states that:

  • Nursing care is directed toward meeting the comprehensive needs of patients and their families across the continuum of care. This is particularly vital in the care of patients and families at the end of life to prevent and relieve the cascade of symptoms and suffering that are commonly associated with dying. Nurses are leaders and vigilant advocates for the delivery of dignified and humane care. Nurses actively participate in assessing and assuring the responsible and appropriate use of interventions in order to minimize unwarranted or unwanted treatment and patient suffering (p.7).



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