Nurses’ attitudes towards Do Not Attempt Resuscitation orders

Abstract

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.

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

“…These data are in accordance with what was reported by O'Hanlon [3] in which only 22% of nurses say they must be involved in such decisions. Fallahi et al [7] show that both the medical and nursing staff claim that DNAR decision should not be taken by the nurses and that even in case of disagreement with that decision, they have to stick with what was decided.…”

“…Since nurses tend to give decision-making responsibility on DNAR decision to the doctor (87%) and are rarely involved in such decisions, they believe that the physician should also be responsible to inform the patient about DNAR decision (90%), in accordance with what was reported by O'Hanlon et al [3] The majority of nurses (61%) believe that the patient should always be informed about DNAR decision, as reported in Naess. [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.…”

“…[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.…”

“…From the research in the literature, the questionnaire was selected from "Nurses' attitudes towards Do Not Attempt Resuscitation orders" study. [3] Subsequently, after having received the consent of the author to translate his study in Italian, the translation has been certified.…”

“…Although the first references date back to the 70s in the United States, today in many countries there is a significant variability in the formulation, registration and application of it. [3] Within the European Union there are important differences both in the approach to cardiopulmonary resuscitation and the topic of the end of life, and for this reason the European Resuscitation Council [4] has drawn up guidelines to homogenize them.…”