Background The values and attitudes of healthcare professionals influence their handling of ‘do-not-attempt-resuscitation’ (DNAR) orders. The aim of this study was a) to describe attitudes, perceptions and practices among Swedish physicians and nurses towards discussing cardiopulmonary resuscitation and DNAR orders with patients and their relatives, and b) to investigate if the physicians and nurses were familiar with the national ethical guidelines for cardiopulmonary resuscitation. Methods This was a retrospective observational study based on a questionnaire and was conducted at 19 wards in two regional hospitals and one county hospital. Results 210 physicians and 312 nurses (n = 522) responded to the questionnaire. Every third (35%) professional had read the guidelines with a lower proportion of physicians (29%) compared to nurses (38%). Around 40% of patients had the opportunity or ability to participate in the DNAR discussion. The DNAR decision was discussed with 38% of patients and the prognosis with 46%. Of the patients who were considered to have the ability to participate in the discussion, 79% did so. The majority (81%) of physicians and nurses believed that patients should always be asked about their preferences before a DNAR decision was made. Conclusions Swedish healthcare professionals take a patient’s autonomy into account regarding DNAR decisions. Nevertheless, as 50% of patients were considered unable to participate in the DNAR discussion, questions remain about the timing of patient participation and whether more discussions could have been conducted earlier. Given the uncertainty about timing, the majority of patients deemed competent participated in DNAR discussions.

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Introduction: Preliminary studies showed that 41,4 % of nurses in a Finnish hospital hesitate to perform defibrillation because of fear of injuring the patient and 22,9% because the patient might die and the nurse would feel guilty. Of 80 paramedics in Oslo 39 % stated that deep compressions could result in serious patient injury. These attitudes can result in bad quality CPR starting with a delay. Hypothesis: We assessed the hypothesis that it is common among health care professionals to feel that CPR might harm the patient, to hesitate to do compressions and to hesitate to defibrillate. Methods: Valid questionnaires were send to nurses working in Kuopio University hospital in Finland, Uppsala Akademiska sjukhuset, Sahlgrenska hospital, Göteborg and Södersjukhuset, Stockholm in Sweden and to paramedics working in Vantaa and Kuopio in Finland, Århus in Denmark and Gothenburg in Sweden. All together 811 nurses and 216 paramedics answered the questions about background data and attitudes towards resuscitation, defibrillation and guidelines. Results: Of paramedics 60% felt that deep compressions could injure the patient and 32% felt the harm caused is bigger than the benefit of compressions. When arriving to the patient 21.5% prioritize intubation and infusion over everything else. Of the nurses 16% hesitate to start CPR because of anxiety, 26% did not feel competent to defibrillate and 21% hesitate to defibrillate because they fear to harm the patient. Still 54.2% had had CPR training at their hospital during the last six months. Nurses that hesitate to start resuscitation felt significantly more often that only doctors should defibrillate. This will delaye defibrillation and lives will be lost. Conclusion: Major changes has to be done in training programs for CPR to ensure better confidence in performing the different tasks involved in resuscitation. Today too many health care professionals feel that CPR might do more harm than good.