title: Striving for good nursing care: nurses' experiences of do not resuscitate orders within oncology and hematology care.
abstract: BACKGROUND
  Within oncology and hematology care, patients are sometimes considered to have such a poor prognosis that they can receive a do not resuscitate order from the physician responsible, stipulating that neither basic nor advanced coronary pulmonary rescue be performed in the event of a cardiac arrest. Studies on do not resuscitate decisions within oncology and hematology units, focusing on the specific role of the nurse in relation to these decisions, are scarce.
  
  
  OBJECTIVE
  The aim of this study was to investigate hematology and oncology nurses' experiences and perceptions of do not resuscitate orders, in order to achieve a deeper understanding of the nurses' specific role in these decisions.
  
  
  METHODS
  A qualitative, descriptive methodology with individual semi-structured interviews was used.
  
  
  METHODS
  A total of 15 nurses from eight hematology/oncology wards in four hospitals in Sweden were interviewed individually.
  
  
  METHODS
  In accordance with national regulations, an ethical review was not required for this study. The research followed international guidelines for empirical research, as outlined in the Helsinki Declaration.
  
  
  RESULTS
  The nurses strived for good nursing care through balancing harms and goods and observing integrity and quality of life as important values. Experienced hindrances for good care were unclear and poorly documented decisions, uninformed patients and relatives, and disagreements among the caregivers and family. The nurses expressed a need for an ongoing discussion on do not resuscitate decisions, including all concerned parties.
  
  
  CONCLUSIONS
  In order to provide good nursing care, nurses need clear and well-documented do not resuscitate orders, and patients and relatives need to be well informed and included in the decisions. To increase the understanding for each other's opinions within the medical team, regular ethical discussions are required.
authors.affiliation: Department of Public Health and Caring Sciences, Sweden mona.pettersson@pubcare.uu.se.
authors.forename: Mona
authors.initials: M
authors.lastname: Pettersson
authors.affiliation: Department of Public Health and Caring Sciences, Sweden.
authors.forename: Mariann
authors.initials: M
authors.lastname: Hedström
authors.affiliation: Department of Public Health and Caring Sciences, Sweden.
authors.forename: Anna T
authors.initials: AT
authors.lastname: Höglund
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D005260:Female; D006405:Hematology / Q000941:ethics*; D006801:Humans; D008297:Male; D009726:Nurses / Q000523:psychology*; D009859:Oncology Nursing / Q000941:ethics*; D016414:Resuscitation Orders / Q000941:ethics / Q000523:psychology*; D013548:Sweden; D013727:Terminal Care / Q000941:ethics / Q000379:methods*
keywords: Communicative ethics; do not resuscitate; end-of-life; hematology; nursing; oncology