A study into the uses and effects of do-not-resuscitate orders in the intensive care units of two teaching hospitals.
Do-not-resuscitate (DNR) orders pose many ethical and moral dilemmas for health professionals. When placed in the context of an Intensive Care Unit (ICU), these dilemmas are magnified. Data were obtained on all admissions to two ICUs over a 3-month period, using a descriptive survey design. During this period 26 patients were deemed not for resuscitation, all of whom were suffering from multiple medical problems. Nursing dependency was found to be unaltered by a DNR order. Medical intervention was unaltered in 13 (52%) of the DNR patients after an order was made, but in the remaining (12) 48% some therapy was withdrawn. One patient was admitted to ICU with a DNR order already having been made on an elderly care ward. 24 (92%) of the DNR patients died in ICU, with a further patient dying on a general ward, and another still an inpatient 3 months after leaving ICU. The patients' family were involved in the discussions regarding resuscitation in 20 (80%) of the cases, and the nursing staff in 17 (68%). The medical input was at a senior level, although the order was generally documented by more junior staff. In six (24%) cases DNR orders were verbal only. These units demonstrate generally good practice regarding DNR decision-making and nursing care. However, explicit documentation is necessary in all cases.
Simpson
S H
SH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015400:Clinical Nursing Research; D003657:Decision Making; D004992:Ethics, Medical; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D009732:Nursing Care; D017063:Outcome Assessment, Health Care; D016414:Resuscitation Orders; D028761:Withholding Treatment