Abstract
This study aimed to evaluate nurses’ experiences and factors related to their attitudes regarding discussions of do-not-resuscitate (DNR) and withdrawal of life-sustaining treatment (LST) with patients and their families. A cross-sectional survey was conducted in a tertiary hospital in Taiwan. Nurses aged ≥ 20 years who were in charge of acute inpatient care were randomly recruited. A semi-structured questionnaire was used to evaluate participants’ experiences and attitudes regarding discussions of DNR and LST withdrawal for terminal patients. Logistic regression with adjustment for covariates was used to analyze factors related to participants’ attitudes toward discussions about DNR and LST withdrawal with patients and families in the future care of terminal patients. The participants were 132 nurses. They had significantly more discussions about DNR and LST withdrawal with patients’ families than with patients. Regression analysis showed that participants who had past experiences in actively initiating DNR discussions with patients or patients’ families were significantly more likely to discuss DNR with patients in the future care of terminal patients, but participants aged 40.0 to 60.0 years were significantly less likely to have DNR discussions than those aged 20.0 to 29.9 years. Experiences of actively initiated DNR or LST discussions with patients’ families were significantly more likely to discuss DNR with patients’ families, but those aged 40.0 to 60.0 years were also significantly less likely to have DNR discussions than those aged 20.0 to 29.9 years. Experience in actively initiating discussions about LST withdrawal with patients’ families, being male, and possessing an education level higher than university were significantly related to LST withdrawal discussions with terminal patients or their families in the future. In conclusion, there need to be more discussions about DNR and LST withdrawal with patients. To protect patients’ autonomy and their rights to make decisions about their DNR and LST, measures are needed to facilitate DNR and LST discussions with patients to ensure better end-of-life care.
Highlights
The 2000 Hospice Palliative Care Act in Taiwan was designed to protect terminally ill patients’rights and wishes regarding their medical treatment
Experience in actively initiating discussions about Life-Sustaining Treatment (LST) withdrawal with patients’ families, being male, and possessing an education level higher than university were significantly related to LST withdrawal discussions with terminal patients or their families in the future
Respondents who had experiences of actively initiating DNR or withdrawal of LST discussions with patients’ families were more likely to have such discussions with patients’ families in the future (OR = 5.03, 95% confidence interval (CI) = 1.31–19.34, p = 0.019; odds ratio (OR) = 7.13, 95% CI = 1.12–45.54, p = 0.038), but those who aged 40.0 to 60.0 years old were less likely to have DNR discussions with patients’ families than respondents who were aged 20.0 to 29.9 years old (OR = 0.058, 95% CI = 0.01–0.49, p = 0.009) (Table 3)
Summary
This study aimed to evaluate nurses’ experiences and factors related to their attitudes regarding discussions of do-not-resuscitate (DNR) and withdrawal of life-sustaining treatment (LST). The aim of this study was to explore these two issues, in the hope to examine whether patients’ rights and autonomy to make decisions about their treatments were protected. This study aimed to evaluate nurses’ experiences and factors related to nurses’ attitudes regarding discussions with patients and family members about DNR and LST withdrawal to evaluate whether patients’ rights and autonomy to make decisions about their treatments were protected
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