Introduction: Do Not Attempt Resuscitation (DNAR) orders represent a difficult and challenging area of practice for many health professionals. Many studies have examined the perspective of physicians, but recent changes have enhanced the role of nurses in the UK. Despite this, there remains a knowledge gap regarding their interactions with DNAR orders. Aim:To explore the opinions and experiences of nursing staff on DNAR orders. Methods:We surveyed nursing staff in a major teaching hospital using a structured tool.Results: 251 nurses were invited to participate in the study. 178 completed forms were received (response rate 70.9%). One third of respondents reported the presence of a resuscitation policy on their ward, although no official policy existed in the hospital. 91% of nurses would resuscitate by default if no decision on DNAR had been made. Most believed that consultants or patients should make decisions, and felt it was the role of the physician to inform the patient. 70% stated that DNAR orders were only clear "sometimes"; and 15% that physicians never discuss them with nurses. 52% said that all hospital patients should be routinely asked if they would like to be resuscitated. 35% have disagreed with a DNAR decision. Nurses overestimated the mean survival rate at cardiac arrests to be 34%. 76% believe they need more training. Conclusion:There is considerable interest in DNAR orders among nursing staff. There was dissatisfaction with regard to how DNAR orders work, including a perceived lack of communication from physicians and lack of clarity in the orders. There is a need for further education and cooperation in this area.
This article analyses the impact of three demographic factors on student attendance 0ver a three-year population level statistical analysis of student attendance rates in Queensland (Australia) state secondary schools. Whole school attendance rates were mapped against the demographic factors of schools’ Index of Community Socio-Educational Advantage (ICSEA) values, proportion of Indigenous students within the school, and school population size as independent variables to identify which schools recorded the highest student attendance as measured by proportion of students with more than 95 per cent average attendance across the years 2014-2016. The geographic and demographic profile of these schools were then assessed to guide direction for future research. The data from this sample of schools indicates no significant relationship between high levels of student attendance and the three independent variables. Subsequent analysis of school location resulted in identification of a significant number of schools in rural locations attaining excellent attendance rates against both study sample schools and state benchmarks. It is evident that several schools have successfully navigated what might be considered challenging school demography to attain higher than average attendance rates. Despite the age of this data, no significant system-wide attendance improvement is presently evident, and the same conditions of challenge remain for schools. The findings suggest a need for a more forensic approach to analysis of school climate and culture to determine factors contributing to student attendance. The data from this sample of schools indicates no significant relationship between high levels of student attendance and the three independent variables, challenging long held assumptions that low socio-economic status and high proportion of indigeneity are significant causal factors for low rates of school attendance. Subsequent analysis of school location resulted in identification of a significant number of schools in rural locations attaining excellent attendance outcomes against both study sample schools and state benchmarks. It is concluded that rather than relying on traditional stereotypes of school demography influencing perception of student attendance patterns, educators must adopt a more forensic approach to analysis of their school climate and culture to determine contributing factors to student attendance excellence. ICSEA is a scale that applies a numerical value to schools in Australia determined by the level of educational advantage experienced by students in the school. ICSEA considers parental occupations, parental level of education, school geographical location and the proportion of indigenous students in the school. An ICSEA of 1000 is the average benchmark value (ACARA, 2014)
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