Nurses’ attitudes towards Do Not Attempt Resuscitation orders

Abstract

Introduction: Do Not Attempt Resuscitation (DNAR) orders represent a difficult and challenging area of practice for many health professionals. Many studies have examined the perspective of physicians, but recent changes have enhanced the role of nurses in the UK. Despite this, there remains a knowledge gap regarding their interactions with DNAR orders. Aim: To explore the opinions and experiences of nursing staff on DNAR orders. Methods: We surveyed nursing staff in a major teaching hospital using a structured tool. Results: 251 nurses were invited to participate in the study. 178 completed forms were received (response rate 70.9%). One third of respondents reported the presence of a resuscitation policy on their ward, although no official policy existed in the hospital. 91% of nurses would resuscitate by default if no decision on DNAR had been made. Most believed that consultants or patients should make decisions, and felt it was the role of the physician to inform the patient. 70% stated that DNAR orders were only clear “sometimes”; and 15% that physicians never discuss them with nurses. 52% said that all hospital patients should be routinely asked if they would like to be resuscitated. 35% have disagreed with a DNAR decision. Nurses overestimated the mean survival rate at cardiac arrests to be 34%. 76% believe they need more training. Conclusion: There is considerable interest in DNAR orders among nursing staff. There was dissatisfaction with regard to how DNAR orders work, including a perceived lack of communication from physicians and lack of clarity in the orders. There is a need for further education and cooperation in this area.