Do-not-attempt-resuscitation orders: attitudes, perceptions and practices of Swedish physicians and nurses

BMC Medical Ethics

Anders Bremer¹  Jörg Carlsson²  Kristofer Årestedt³  Samuel Sandboge⁴  Ewa Rosengren⁵ 

[1] Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Universitetsplatsen 1, 35195, Växjö, Sweden;Department of Ambulance Service, Region Kalmar County, Lasarettsvägen 37, 39244, Kalmar, Sweden;University of Borås, Allégatan 1, 50190, Borås, Sweden;Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Universitetsplatsen 1, 35195, Växjö, Sweden;Department of Medicine, Section of Cardiology, Kalmar County Hospital, Box 601, 39126, Kalmar, Sweden;Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Universitetsplatsen 1, 35195, Växjö, Sweden;The Research Section, Box 601, Region Kalmar County, 39126, Kalmar, Sweden;Population Health Unit, Finnish Institute for Health and Welfare, Box 30, 00271, Helsinki, Finland;The Cardio Thoracic Intensive Care Unit, Karolinska University Hospital, Region Stockholm, Eugeniavägen 23, 17164, Solna, Sweden;

关键词: Attitudes;    Autonomy;    Cardiac arrest;    DNAR order;    Informed consent;    Nurses;    Physicians;   

DOI  :  10.1186/s12910-021-00604-8

来源: Springer

【 摘 要 】

BackgroundThe values and attitudes of healthcare professionals influence their handling of ‘do-not-attempt-resuscitation’ (DNAR) orders. The aim of this study was a) to describe attitudes, perceptions and practices among Swedish physicians and nurses towards discussing cardiopulmonary resuscitation and DNAR orders with patients and their relatives, and b) to investigate if the physicians and nurses were familiar with the national ethical guidelines for cardiopulmonary resuscitation.MethodsThis was a retrospective observational study based on a questionnaire and was conducted at 19 wards in two regional hospitals and one county hospital.Results210 physicians and 312 nurses (n = 522) responded to the questionnaire. Every third (35%) professional had read the guidelines with a lower proportion of physicians (29%) compared to nurses (38%). Around 40% of patients had the opportunity or ability to participate in the DNAR discussion. The DNAR decision was discussed with 38% of patients and the prognosis with 46%. Of the patients who were considered to have the ability to participate in the discussion, 79% did so. The majority (81%) of physicians and nurses believed that patients should always be asked about their preferences before a DNAR decision was made.ConclusionsSwedish healthcare professionals take a patient’s autonomy into account regarding DNAR decisions. Nevertheless, as 50% of patients were considered unable to participate in the DNAR discussion, questions remain about the timing of patient participation and whether more discussions could have been conducted earlier. Given the uncertainty about timing, the majority of patients deemed competent participated in DNAR discussions.

【 授权许可】

CC BY