Do Not Attempt Cardiopulmonary Resuscitation orders in acute medical settings: a qualitative study

Abstract

DNACPR orders can act as unofficial 'stop' signs and can often signify the inappropriate end to clinical decision making and proactive care. Many clinicians were uncomfortable discussing DNACPR orders with patients and families. These findings help understand why patients with DNACPR orders have worse outcomes, as such they may inform improvements in resuscitation policies.

Reversing the Stop Signs to Proactive Nursing Care in DNR Patients

“…Research has supported that patients with a do-not-resuscitate (DNR) code status receive less aggressive treatment and have higher mortality rates compared to those without DNR orders, after adjusting for confounding factors (Cohn et al, 2012). Most healthcare workers believe in having DNR orders and that in many cases DNR is appropriate to safeguard patients from further harm and in obvious futile cases (Hewitt & Marco, 2004).…”

“…The result is less aggressive medical care being delivered to patients with the DNR order as compared to patients without the order (Cohn et al, 2012). This reference was used in the first paragraph with listing of all authors.…”

“…Cohn et al (2012) conducted a qualitative study that employed interviews and observation methods. A non-medical field assistant was used to obtain observation data with a non-bias perspective.…”

“…Research has supported that patients with a do-not-resuscitate (DNR) code status receive less aggressive treatment and have higher mortality rates compared to those without DNR orders, after adjusting for confounding factors (Cohn, Fritz, Frankau, Laroche, & Fuld, 2012). Health care providers erroneously understand DNR status to imply that a patient is dying and should not undergo other life-saving interventions (Hewitt & Marco, 2004).…”

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AbstractResearch has supported that patients with a do-not-resuscitate (DNR) code status receive less aggressive treatment and have higher mortality rates compared to those without DNR orders, after adjusting for confounding factors (Cohn, Fritz, Frankau, Laroche, & Fuld, 2012). Health care providers erroneously understand DNR status to imply that a patient is dying and should not undergo other life-saving interventions (Hewitt & Marco, 2004).

Surveyed critical care nurses revealed that they believed that interventions such as complete history and physicals, checking vital signs, monitoring neuro status, and ICU admission should not be performed as regular interventions on patients with a DNR status (Sherman & Branum, 1995).

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