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

Abstract

Background: Despite 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”. Methods: A 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. Results: Totally, 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). Conclusions: Given 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.

Do-Not-Resuscitate (DNR)

“…A DNR order is the order for the healthcare professionals not to perform CPR on a patient with cardiac arrest or pulmonary arrest (cardio-respiratory arrest) [3][4][5][6][7][8]9 .…”

“…Most of the physician are not acquainted when to issue and implement DNR orders and with whom to discuss and negotiate. There is also difference of opinion among healthcare professionals 3,5 .…”

“…The DNR decision-making process varies in different countries and among countries 1,16 .The difference of opinion in belief, acceptance, acknowledgment and approval with regards to performance, morality and legality have been observed in different societies, cultures, ethnicities and religions [5][6][7][8][9][10][11][12][13][14][15][16][17]18 .…”

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

“…The major concern should be the best interest of the patient, and the law should not drive medical decisions. 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…”

“…A DNR decision for oncology and hematology patients not only depends on medical factors such as prognosis or life expectancy after resuscitation. There are further ethical aspects such as quality of life and patient autonomy that need to be considered 12 …”