The influence of DNR orders on patient care in adult ICUs: a review of the evidence.
BACKGROUND
Although do-not-resuscitate (DNR) orders have been used in health care for many years, there is controversy about their use and the implications for patient care. A common perception in the intensive care unit (ICU) setting is that life-sustaining interventions such as dialysis or mechanical ventilation may no longer be provided or should be withdrawn on patients who are assigned DNR status. In order to gain insight into the impact of DNR orders on the care provided to adult patients in the ICU, a review of the research conducted on this topic within the last decade was undertaken.


OBJECTIVE
To provide an integrated review of recent research examining the effects of DNR orders on the care of adult ICU patients.


METHODS
Two large databases, CINAHL and MEDLINE, were used for the search as well as the reference lists from relevant research articles. The search terms used were: DNR orders in adult ICUs, resuscitation orders, critical care, and nursing and/or medical care provided to these patients. Studies were not limited to any one specific research design. The search was restricted to research conducted over the last decade.


RESULTS
Five studies were found that met the search criteria.


CONCLUSIONS
While the care that critically ill adult patients receive in ICUs is, in some way, influenced by DNR orders, there is no evidence that patients are abandoned as a result. Given the inconsistency in the findings of the five studies and certain weaknesses in methodology, it is not possible to identify a direct impact of DNR orders on patients care at this time. Further investigation is needed.
Chu
Winnie
W
Adult Intensive Care Unit, Mount Sinai Hospital, Toronto, Ontario.
Hynes-Gay
Patricia
P
D000328:Adult; D003422:Critical Care; D016638:Critical Illness; D006801:Humans; D007362:Intensive Care Units; D006435:Renal Dialysis; D016414:Resuscitation Orders