Characteristics and outcomes of “Do Not Resuscitate” patients admitted to the emergency department–Intensive care unit

Wang, An Yi; Ma, Hon Ping; Kao, Wei Fong; Tsai, Shin Han; Chang, Cheng

doi:10.1016/j.jfma.2018.03.016

Cited by 9 publications

(7 citation statements)

References 16 publications

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“…To develop the vignettes for this study and determine the clinical practices to be assessed, we held a group discussion with seven nurses working in the study location. The vignettes were developed to reflect representative patients hospitalized with non-malignant chronic diseases, including various patient characteristics previously determined to influence nursing care (Henneman et al 1994;Fairman et al 2011;Osinski et al 2017;Wang et al 2019). The following three vignettes were used in the survey.…”

Section: Development Of Vignettesmentioning

confidence: 99%

“…The primary focus of previous studies on DNAR orders has been in connection with intensive care or palliative care for patients with advanced cancer. Few studies have been performed on patients with non-malignant chronic illness such as cardiovascular and pulmonary diseases (Trivedi 2013;Wang et al 2019). Patients with nonmalignant chronic diseases experience longer periods of therapeutic interventions and more unpredictable prognoses than those undergoing intensive care or who have advanced cancer, resulting in them being more likely to change their mind about DNAR orders.…”

Section: Introductionmentioning

confidence: 99%

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Absence of Relatives Impairs the Approach of Nurses to Cardiopulmonary Resuscitation in Non-Cancer Elderly Patients without a Do-Not-Attempt-Resuscitation Order: A Vignette-Based Questionnaire Study

Higuchi

Takita

Yoshii³

et al. 2020

Tohoku J. Exp. Med.

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A Do-Not-Attempt-Resuscitation (DNAR) order solely precludes performing cardiopulmonary resuscitation (CPR) following cardiopulmonary arrest. A patient's personal status is known to influence a range of clinical practices, not only CPR, when a DNAR order is given. We assessed whether the absence of supporting relatives or a diagnosis of dementia can influence nurses' perceptions of clinical practices for elderly patients with non-malignant and chronic diseases. A vignette-based questionnaire was used to evaluate nurses' beliefs both before and after issuance of a DNAR order. Three vignettes were developed: the control vignette described an 85-year-old woman with repeated heart failure, the second and third incorporated a lack of relatives and a dementia diagnosis, respectively. The survey assessed the approach of nurses to 10 routine medical procedures, including CPR, clinical laboratory testing and nursing care, using a 5-base Likert-scale, for six vignette scenarios. A questionnaire was completed by 186 nurses (64% response). The pre-DNAR non-relative vignette showed significantly lower scores for CPR, indicating a deterioration in willingness to perform CPR, compared to the pre-DNAR control (median [interquartile]; 3 [2-4] and 4 [3-4] in the non-relative and control vignettes, respectively, p < 0.001). No significant differences were observed between the dementia and control vignettes. Absence of contactable relatives and resultant lack of communication can diminish the perception of nurses regarding the provision of CPR, even when a DNAR does not exist. This result suggests a necessity for comprehensive training all medical staff about issuance of DNAR orders and what care should be provided thereafter.

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Section: Development Of Vignettesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Absence of Relatives Impairs the Approach of Nurses to Cardiopulmonary Resuscitation in Non-Cancer Elderly Patients without a Do-Not-Attempt-Resuscitation Order: A Vignette-Based Questionnaire Study

Higuchi

Takita

Yoshii³

et al. 2020

Tohoku J. Exp. Med.

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“…Moreover, there are no guidelines or protocols that can help patients, families and physicians make such decisions. 18–20 …”

Section: Introductionmentioning

confidence: 99%

Understanding perceptions and factors involved in do not resuscitate (DNR) decision making in the emergency department of a low-resource country: a mixed-methods study protocol

et al. 2020

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IntroductionDo not resuscitate (DNR) decision making is an integral component of emergency medicine practice. There is a paucity of data, protocols and guidelines regarding the perceptions and barriers that are involved in the interactions among healthcare professionals, patients and their caregivers regarding DNR decision making. The aim of this study is, therefore, to explore the perceptions and factors influencing DNR decision making in the emergency department and to evaluate the use of a context-based protocol for DNR decision making.Methods and analysisThis will be a sequential mixed method study beginning with qualitative research involving in-depth interviews (IDIs) with patient family members and focus group discussion with healthcare professionals. The consensual qualitative approach will be used to perform a thematic analysis to the point of saturation. The expected outcome will be to identify key themes that suggest perceptions and factors involved in DNR decision making. After piloting, the derived protocol will then be used with a different group of individuals (150 healthcare professionals) who meet the eligibility criteria in a quantitative cross-sectional study with universal sampling. Data will be analysed using NVIVO in the qualitative phase and SPSS V.19 in the quantitative phase. The study findings will support the development of a standardised protocol for DNR decision making for healthcare professionals in the emergency department.Ethics and disseminationThe proposal was reviewed by the ethics review committee (ERC) of the institution (ERC # 2020-1551-7193). The project is an institution SEED grant recipient PF139/0719. The results will be disseminated among participants, patient communities and healthcare professionals in the institution through seminars, presentations, brochures and emails. The findings will be published in a highly accessed peer-reviewed medical journal and will be presented at international conferences.

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“…Research on DNAR orders has primarily been advancing in the intensive care or clinical management for patients with advanced cancer (Trivedi, 2013; Wang, Ma, Kao, Tsai, & Chang, 2018). This is particularly because problems related to DNAR orders, such as consent given by substitutes because of patients’ minimally conscious states, are frequently discussed in the field of intensive care or palliative care for people with cancer with advanced stage.…”

Section: Introductionmentioning

confidence: 99%

Nurses’ perceptions of medical procedures and nursing practices for older patients with non‐cancer long‐term illness and do‐not‐attempt‐resuscitation orders: A vignette study

Higuchi

Yoshii²,

Takita

et al. 2020

Nursing Open

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Aim To elucidate influence of a do‐not‐attempt‐resuscitation (DNAR) order on nurses’ perceptions of the medical procedures and nursing practices for non‐cancer older patients. Design A vignette‐based questionnaire study. Methods A questionnaire survey asking nurses their perceptions of clinical practices for the following three vignettes was performed in a community hospital in Japan (N = 120): the control vignettes with an older patient with repeated heart failure who was living alone and the other two with either an absence of relatives or a diagnosis of dementia. We also prepared additions to each vignette describing a DNAR order. Results Nurses’ perception on cardiopulmonary resuscitation, defibrillation, blood tests and intravenous nutrition showed statistically significant and minimally important declines after the DNAR order compared with before for all three vignettes (p < .001). DNAR orders can influence nurses’ perceptions of clinical practices for non‐cancer older patients with chronic heart failure.

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Characteristics and outcomes of “Do Not Resuscitate” patients admitted to the emergency department–Intensive care unit

Cited by 9 publications

References 16 publications

Absence of Relatives Impairs the Approach of Nurses to Cardiopulmonary Resuscitation in Non-Cancer Elderly Patients without a Do-Not-Attempt-Resuscitation Order: A Vignette-Based Questionnaire Study

Absence of Relatives Impairs the Approach of Nurses to Cardiopulmonary Resuscitation in Non-Cancer Elderly Patients without a Do-Not-Attempt-Resuscitation Order: A Vignette-Based Questionnaire Study

Understanding perceptions and factors involved in do not resuscitate (DNR) decision making in the emergency department of a low-resource country: a mixed-methods study protocol

Nurses’ perceptions of medical procedures and nursing practices for older patients with non‐cancer long‐term illness and do‐not‐attempt‐resuscitation orders: A vignette study

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