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

Abstract

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.

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.…”

“…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. [7] Even if the decision-making responsibility is attributed to the physicians, part of the nursing community desires to be more involved in DNAR decisions. In particular, nurses wish to be consulted, like physicians, as holders of a unique relationship that binds them to patients.…”

“…[10] The responsibility to inform and receive the patient's consent for the DNAR order is attributed only to physicians. [7]…”

The do not resuscitate order (DNR) from the perspective of oncology nurses: A study in Saudi Arabia

“…However, as it stands, the existing law sometimes hinders ethical decision making. 12 Many doctors and nurses know that the outcome for a patient is terminal, and yet they still use CPR when the patient is in a critical condition. 3 Cancer patients in the end-stage of the disease frequently get minimal benefit from aggressive treatment that often involves greater suffering and burden on the patient and their family.…”

“…There are further ethical aspects such as quality of life and patient autonomy that need to be considered. 12 The participation of nurses in the DNR decision-making process has been recognised as a key to attaining optimal decisions. 12 As suggested by Fallahi et al, more research studies are required to fully understand the barriers behind the reduced involvement of nurses, patients, and families in the DNR decision and to determine how to enhance the nurse's role as a patient advocate.…”