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

Masoud Fallahi, Somaye Mahdavikian, Alireza Abdi, Fariba Borhani, Parvin Taghizadeh, Behzad Hematpoor

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". 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. 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). 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.