Critical Care Nurses' Knowledge and Attitudes Regarding the "Do Not Resuscitate Status"

Abstract

Background: Patients in the critical care unit (CCU) are, by definition, the sickest patients in acute care hospitals and face higher risk of death than any other hospital population and usually require advanced life support such as mechanical ventilation, inotropes, or dialysis. Since every day critical care nurses encounter death and dying in the critical care units, Nurses are vital to end-of-life care as they are the ones present at the bedside, they have an opportunity to observe behaviours and actions that are barriers to a peaceful and dignified death while they provide end-of-life care. Do-notresuscitate orders (DNR) are used in many countries to limit the use of cardiopulmonary resuscitation (CPR) in certain situations. There is still a continuing debate about the ethics, legalities and the appropriate medical indications for use of DNR. The status of DNR can raise many issues for nurses, including ethical dilemmas, conflict, and power struggles among members of the health care team.

Knowledge and Attitude towards Do-Not-Resuscitate Order among Nurses of a Tertiary Level Hospital

“…Somewhat similar results were found in the study conducted in Syrian Arab Republic where 74.6% of the respondents knew about pain medications and 94.3% knew that DNR order is in written form. 14 Attitude on DNR Order: Regarding the attitude towards factors influencing DNR order and feeling surrounding DNR status domains, 78.6% of the respondents in the present study agreed that medical condition of the patient should be considered in DNR order which is consistent with the findings of study conducted in Syrian Arab Republic. 14 Similarly, the findings of the present study showed that majority (58.6%) of respondents disagreed to the negative statement that every critically ill patient should have DNR order.…”

“…14 Attitude on DNR Order: Regarding the attitude towards factors influencing DNR order and feeling surrounding DNR status domains, 78.6% of the respondents in the present study agreed that medical condition of the patient should be considered in DNR order which is consistent with the findings of study conducted in Syrian Arab Republic. 14 Similarly, the findings of the present study showed that majority (58.6%) of respondents disagreed to the negative statement that every critically ill patient should have DNR order. Whereas the study conducted among 140 nurses in Syrian Arab Republic found that only 38.7% of the respondents disagreed with the statement.…”

“…This finding is somewhat similar to the finding of study conducted in Syrian Arab Republic among 140 critical care nurses, which found that 83.6% nurses knew that DNR does not mean do-not-care. 14 The present study also found that almost all (94.3%) respondents knew correctly that CPR is not done in patient with DNR order whereas the study done in 66 NICU nurses of an academic university hospital in the North Eastern United States found that only 24.2% nurses knew correctly the meaning of DNR as withholding CPR only. 15 Regarding the nurses' knowledge about decision making process domain the present study revealed that majority (68.6%) of the respondents had the knowledge that DNR order cannot be overruled and that most (81.4%) of them had the knowledge that they are obligated to initiate CPR if there is no DNR designation.…”

“…It is somewhat consistent with the finding of the study conducted in Syrian Arab Republic where 82.1% respondents knew that emotional support is essential. 14 In regards to nurses' knowledge on medical management and documentation domains in the present study, 97.1% of the respondents knew pain relieving medicines are administered to patients with DNR order as per need and same percentage of the respondents knew that DNR order is given in written form. Somewhat similar results were found in the study conducted in Syrian Arab Republic where 74.6% of the respondents knew about pain medications and 94.3% knew that DNR order is in written form.…”

“…Whereas the study conducted among 140 nurses in Syrian Arab Republic found that only 38.7% of the respondents disagreed with the statement. 14 This discrepancy may be due to cultural differences. Less than half (47.2%) proportion of the respondents in present study agreed to the negative statement that it is depressing to find patient in DNR order which is somewhat similar to the finding of the study in Syrian Arab Republic where 35.0% of respondents always found the situation as depressing.…”