Table 4 - uploaded by Saeer Naheem Taha
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Background: Patients in the critical care unit (CCU) are, by definition, the sickest patients in acute care hospitals and face higher risk of death than any other hospital population and usually require advanced life support such as mechanical ventilation, inotropes, or dialysis. Since every day critical care nurses encounter death and dying in the...
Citations
... 152 Assuring patient that his condition will improve is essential. 14 The disparity in findings may be due to difference in cultural background of the respondents. ...
... Syrian Arab Republic where 35.0% of respondents always found the situation as depressing.14 Similarly, 50.0% of the respondents in the present study agreed to the negative statement "powerless is felt by the nurses while looking at the family of DNR patient". ...
Introduction: Knowledge regarding and attitude towards end-of-life care can shape the behaviour and actions of a health professional in provision of supportive care for the comfort of the patients as well as their family members. Very little is known about nurses’ knowledge and attitude regarding do-not-resuscitate (DNR) order. Therefore, the purpose of this study was to identify the knowledge of and attitude towards DNR order and relationship between knowledge and attitude towards DNR order among the nurses of a tertiary level hospital. Methods: Descriptive correlation design was used. Convenient sampling method was used to select 70 nurses from a tertiary level hospital. Data were collected using pretested self administered structured questionnaire. Data were analysed using SPSS version 20 and analysed using descriptive and inferential statistics. Result: Among 70 respondents, almost all (95.7%) of the respondents had good level of knowledge, 2.9% had fair and 1.4% had poor level of knowledge. Most (80.0%) of the respondents had positive attitude towards DNR order and 20.0% had negative attitude. There was a positive relationship between knowledge of and attitude towards DNR order (r = 0.068) but the relationship was statistically insignificant. Conclusions: Based on the findings, the study concludes that nurses of tertiary level hospital have good knowledge and positive attitude towards DNR order. Likewise, knowledge regarding DNR order is related with the attitude towards DNR order and thus knowledge can be enhanced to improve the attitude towards DNR by regular in-service education.
Background
Healthcare Professionals (HCPs) are important stakeholders and gatekeepers in resuscitation decision-making. This systematic review explored the views and attitudes of HCPs on do-not-attempt-cardiopulmonary resuscitation (DNAR) in low-and-lower-middle-income countries (LLMICs).
Methods
PubMed, EMBASE, PsycInfo, CINAHL, Cochrane library, Scopus, and Web of Science were searched from 01-Jan-1990 to 24-February-2023. Empirical peer-reviewed literature exploring views and attitudes of HCPs on DNAR for adult patients (aged ≽18 years) in LLMIC were included. No restriction on empirical study designs was imposed. Two independent reviewers performed screening, data extraction and critical appraisal. Hawker’s tool and Popay’s narrative synthesis were used for critical appraisal and data synthesis respectively. Review findings were interpreted using Cognitive Dissonance theory (CDT).
Results
Of the 5132 records identified, 44 studies encompassing 7490 HCPs were included. The median Hawker score was 28 with 27% studies having low risk of bias. Three themes emerged. 1: Meaning-Making of DNAR construct. Most HCPs agreed that DNAR avoided inappropriate resuscitations, needless suffering and allowed fair allocation of resources. However, there was a lack of consensus on DNAR timing. 2: Barriers and Facilitators. Sociocultural norms, lack of legal clarity, organisational policies, societal and family views, religious and ethical beliefs, and healthcare providers’ presuppositions often hindered DNAR practice. HCPs had inconsistent religious and ethical beliefs about DNAR. 3: Tensions and complexities of contemporary practice. HCPs expressed fears, concerns, guilt and distress while recommending DNAR. HCPs differed on involving patients. The DNAR practice was arbitrary and suboptimal like informal DNAR orders, pretended and symbolic CPRs.
Conclusion
Most HCPs in LLMICs viewed DNAR as essential However, they faced barriers to DNAR implementation at macro-(law, sociocultural norms), meso-(organization) and micro-(HCP- and family views) levels. These barriers contributed to HCPs’ fears, concerns and distress concerning DNAR. The CDT provided the lens to link HCPs cognitions, affect and behaviour into a chain of events that explained suboptimal resuscitation practices.
Trial registration
CRD42023395887.
“Do Not Resuscitate” (DNR) order is one of the challenging issues encountered in end of life care. This study aimed to determine the effect of education about DNR on the views of senior nursing students. Students, who selected elective course of palliative care and received education about DNR formed the intervention group (n = 106) while the students who did not select the lesson were in the control group (n = 107). Data were collected using a questionnaire. It revealed that the students who had education about DNR agreed with the positive statements about DNR more than the control group. Also, intervention group students had a high agreement DNR should be a part of vocational training for health professionals. It is important and necessary to focus on the special role of nurses when a DNR order is given, and nursing education raised the awareness and views about DNR according to the data from this study.
