Implementing a resuscitation policy for patients at the end of life in an acute hospital setting: qualitative study.
OBJECTIVE
To explore attitudes and experiences of doctors and nurses regarding cardiopulmonary resuscitation for patients with end stage illness in an acute hospital.


METHODS
Qualitative study; thematic analysis of two audio-taped focus groups and four semi-structured interviews.


METHODS
Acute district hospital, Northern Ireland.


METHODS
Seven nurses and nine doctors; varying nationality, gender and years of professional experience; involved in cardiopulmonary resuscitation decision-making.


RESULTS
Participants reported different interpretations of resuscitation policy and of what do not attempt to resuscitate (DNAR) decisions meant in relation to practical care for patients. This confusion in translating policy into practice contributed to communication difficulties in initiating, documenting and implementing cardiopulmonary resuscitation decisions. Participants were aware of how clinical conditions could change and reported uncertainty in determining end stage illness; they expressed fears of potential consequences of DNAR decisions for patients' care. The more disease-centred approach of doctors to patients' management, compared to nurses' more patient-centred approach, contributed to inter-professional conflict within teams. Doctors identified training needs in applying resuscitation policy and ethical principles in ;real life' and nurses identified a need for ongoing professional support, which was perceived as being less available to junior doctors. Personal relationships between staff and patients, cultural reluctance to address sensitive issues and local community expectations of relatives being involved in decisions added to policy implementation difficulties.


CONCLUSIONS
The findings indicate a need for ongoing staff support and training in applying resuscitation policy to decisions for patients with end stage illness in an acute hospital. They support suggestions that reviews of local resuscitation policy and of national guidelines should be undertaken with openness and honesty regarding the goals, opportunities and difficulties involved in trying to deliver good end of life care in local settings.
Palliative Medicine, Sperrin Lakeland Trust, Tyrone County Hospital, Omagh, Co Tyrone, Northern Ireland. frobinson@slt.nhs.uk
Frances
F
Robinson
Margaret
M
Cupples
Mairead
M
Corrigan
D000328:Adult; D001291:Attitude of Health Personnel; D016887:Cardiopulmonary Resuscitation; D003142:Communication; D003657:Decision Making; D004992:Ethics, Medical; D017144:Focus Groups; D006767:Hospitals, District; D006801:Humans; D007407:Interviews as Topic; D018447:Medical Futility; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009660:Northern Ireland; D009726:Nurses; D036301:Qualitative Research; D016414:Resuscitation Orders / Q000941:ethics / Q000523:psychology*; D013727:Terminal Care / Q000379:methods*