Reversing the Stop Signs to Proactive Nursing Care in DNR Patients

Abstract

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).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). The purpose of this paper was to explore the factors that contribute to less aggressive nursing care in DNR patients that are not actively dying from a terminal illness. This study employed a qualitative approach using semistructured interviews. The sample consisted of five critical care registered nurses. Three common themes were revealed: the definition of DNR code status; interpersonal relationships between nurse/patient; and personal views and feelings directing nursing care. Recommendations and implications for practice are discussed.