Do-not-resuscitate order: The experiences of iranian cardiopulmonary resuscitation team members

Assarroudi, Abdolghader; Nabavi, Fatemeh Heshmati; Ebadi, Abbas; Esmaily, Habibollah

doi:10.4103/0973-1075.197946

Cited by 12 publications

(12 citation statements)

References 26 publications

(35 reference statements)

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“…[15] The principle key of the law [2] is that every person is the subject of care and has the right -if he or she wantsto be properly informed and to guide decisions, accepting or rejecting responsibly any therapeutic proposal that does not conform to his/her project of life: it is therefore the person with his personal history the center of care and the reference point of every decision. [6] The nurses of the sample of this study have a more positive attitude (75%), compared to the study of O'Hanlon et al, [3] also in regularly consulting patients about their wishes.…”

Section: Question Textmentioning

confidence: 48%

“…[5] The verbal transmission of the DNAR order, and therefore its informality, in fact, causes in nurses the fear of possible legal re-runs, in particular from the patient's family, in the event that this order is applied in clinical practice. [6] The responsibility in the DNAR decision is attributed, by most nurses, only to physicians, although this decision should be agreed with other physicians, ethics committees and nurses. Both physicians and nurses, in fact, tend to claim that this decision should not be taken by the latter and that, even in the event of disagreement with the DNAR order, nurses should adhere to this order.…”

Section: Introductionmentioning

confidence: 99%

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Nurses and guideline for interrupting or not initiating CPR: An exploratory survey

Agnoletto

Gastaldo

Padrin

2019

CNS

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Objective: An area that still causes difficulties and a sense of inadequacy in healthcare providers is related to Do Not Attempt Resuscitation decision (DNAR). The aim of the study is to investigate knowledge, opinions and behaviors of nurses about DNAR in order to plan appropriate improvement interventions. Methods: An anonymous questionnaire was administered to 207 nurses belonging to four Medicine Departments and to four Intensive Care areas. The questionnaire, which consists of 29 items, collects some information related to work experience and investigates opinions and behaviors of nurses about DNAR decision. Results: 55% of the nurses in the sample say they do not know the meaning of the acronym DNAR. It was noted a statistically significant association both between training and knowledge of DNAR (p-value = .038) and between years of work and knowledge of the acronym (p-value = .004). There was also a statistically significant difference between knowledge of the acronym and some opinions and behaviors of nurses, including the importance of informing the patient about DNAR decision (p-value = .028). Conclusions:The study shows that the sample investigated, regardless of the work area of afference, does not know DNAR decision adequately. The lack of knowledge influences opinions and attitudes of nurses in relation to DNAR decision, constituting a barrier for an appropriate management of the patient. The need for more training on the topic and the formulation of clear protocols on DNAR decision emerges.

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Section: Question Textmentioning

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Nurses and guideline for interrupting or not initiating CPR: An exploratory survey

Agnoletto

Gastaldo

Padrin

2019

CNS

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“…[25] This supports those of other qualitative studies that emphasize the need for new clinical guidelines and policies that authorize the legal issuance of DNR orders for patients who are in their final dying moments. [2627]…”

Section: Discussionmentioning

confidence: 99%

Investigating the attitude of healthcare providers, patients, and their families toward “do not resuscitate” orders in an Iranian Oncology Hospital

Bordbar

Tavakkoli

Nahidi

et al. 2019

Indian J Palliat Care

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Aim:The decision-making process for do-not-resuscitate (DNR) order has always been challenging. Cultural and religious issues have limited the issuance and execution of DNR orders in Iran. The purpose of this study was to assess the attitude of the nurses, physicians, patients, and their families toward the DNR order.Subjects and Methods:In this cross-sectional study, 343 participants (201 patients, 95 family members, and 47 healthcare providers) from Omid Oncology Hospital, Mashhad, Iran, were surveyed during 2017–2018. All the participants were asked to fill in a checklist of demographic information and a validated questionnaire about their attitude toward DNR orders after giving consent. The data were analyzed using SPSS software and values of P < 0.05 were considered statistically significant.Results:Overall, 201 patients and 95 of their family members, as well as 47 healthcare providers (doctors and nurses), were surveyed. The mean age of participants was 48.75 ± 15.62 years. The attitude of the participants regarding the DNR order was significantly different in 10 of the 11 items (P ≤ 0.005). Among the three groups of participants, healthcare providers showed the most positive attitude regarding the DNR order. The attitude of participants regarding the DNR orders was significantly associated with age, occupation status, residential place, educational status, and income level (P < 0.05).Conclusions:Various factors, such as economic status, level of education, place of residence, and gender, can be effective on decision-making regarding the DNR orders. Unified and sustained education regarding moral and cultural issues can be helpful in the reconciliation of the attitudes between caregivers and patients.

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“…There are a few researches comparing attitudes of physicians and nurses toward issuing and implementing DNAR orders in Iran. Therefore, and taking into account the importance of DNAR order for the patients in terminal phase, its challenging nature for the medical staff, lack of routine and legal procedures, and the importance of the medical staff’s attitudes for deciding and executing DNAR order [ 16 ], the present study was conducted to compare the nurses and physicians’ attitudes about DNAR order in educational hospitals affiliated with Kermanshah University of Medical Science.…”

Section: Introductionmentioning

confidence: 99%

Nurses and physicians’ viewpoints about decision making of do not attempt resuscitation (DNAR)

Fallahi

Mahdavikian

Abdi

et al. 2018

Multidiscip Respir Med

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BackgroundDespite advances with regard to “do not attempt resuscitation order”, physicians are still reluctant to implement it. In fact, while the nurses could be of great help in making decision about “do not attempt resuscitation order,” they are mostly neglected in this process. The current study was conducted to determine the nurses and physicians’ viewpoints about decision making process of “do not attempt resuscitation order”.MethodsA descriptive analytical study was carried out with participation of 152 physicians and 152 nurses. The participants were selected through stratified quota sampling from three educational hospitals affiliated with Kermanshah University of Medical Sciences. Data gathering tools were a demographics checklist and a researcher-designed questionnaire with 20 statements for measuring the attitudes of the respondents about the decision-making process and implementation of “do not attempt resuscitation order” of incurable patients.ResultsTotally, 304 respondents (152 nurses and 152 physicians) participated in the study. The nurses’ attitude score about the consent of the competent patients to “do not attempt resuscitation” was significantly lower in comparison with the physicians, (p < 0.001). However, the nurses’ attitude was more positive than the physicians attitude about the belief that “taking the patient’s consent is the physician’s responsibility” (p < 0.001). Moreover, the nurses’ attitude was more negative compared with the physicians’ attitude about the idea that “obtaining the patient’s consent is the nurse’s responsibility” (p < 0.001). Both groups believed that the nurses cannot recommend “do not attempt resuscitation order” (p < 0.770). Both groups of the respondents believed that the nurses were not qualified to issue the “do not attempt resuscitation order” (physicians’ mean score = 2.85, nurses’ mean score = 2.89). The physicians’ believe in “necessity to negotiate with the nurses about the order” was less deep than that of the nurses (p = 0.035).ConclusionsGiven the different attitudes of the nurses and the physicians about the decision-making process of “do not attempt resuscitation,” it is necessary to codify a medical guideline and clarify the decision making and implementation process. The guideline needs to clearly state physician's, nurse's, patient's, and other medical team members’ responsibilities and roles, respectively.

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Do-not-resuscitate order: The experiences of iranian cardiopulmonary resuscitation team members

Cited by 12 publications

References 26 publications

Nurses and guideline for interrupting or not initiating CPR: An exploratory survey

Nurses and guideline for interrupting or not initiating CPR: An exploratory survey

Investigating the attitude of healthcare providers, patients, and their families toward “do not resuscitate” orders in an Iranian Oncology Hospital

Nurses and physicians’ viewpoints about decision making of do not attempt resuscitation (DNAR)

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