Framing conversations
| “There’s nothing wrong with having a [code status] order set that explicitly says what the patient wants. And maybe it’s a drop-down menu, right, maybe that’s easy. The problem with that is… it will become… a guide to having a productive and healthy patient interaction. You will have a guide for: ‘Do you want this? Do you want this? Do you want this? Do you want this? Okay, I had the conversation.’ Because that’s the path of least resistance for most providers under time pressure.” (Interview 29) |
Prompting decisions
| “I do like having to think about in advance if somebody wants to go to the ICU because you don’t want to think about that stuff when you’re rapid responding somebody… it’s nice to know in advance would this person want [noninvasive positive pressure ventilation] or would they want [high flow nasal cannula], and that way you can guide yourself especially in those emergency but not code situations. So I like that about our [code status options].” (Interview 21) |
Shaping inferences
| “When I see [a May Intubate, DNAR order], I can glean that either the person has a primary respiratory problem… or I sometimes will think, oh, maybe this person has been intubated before and so they know what it means and may be okay doing that again… So those are inferences or assumptions that I might make when I see those code statuses.” (Interview 24) |
Creating categories
| “It seems like it’s too binary, you know, Full or DNR/DNI, and that’s not just the institution, that’s not just the EMR [electronic medical record] or like the way the order is written, it’s also the community, it’s sort of… the institutional culture that the code status is binary, that we don’t like to accept that there’s gradations, that there are people that want to be DNR but do intubate.” (Interview 10) |