title: Cultural perspectives of older nursing home residents regarding signing their own DNR directives in Eastern Taiwan: a qualitative pilot study.
abstract: BACKGROUND
  Chinese tradition and culture developed from Taoism, Confucianism, and Buddhism and have influenced ethnic Chinese for thousands of years, particularly thoughts on death. Many ethnic Chinese, particularly older people, refrain from discussing death-related concerns, making it difficult to obtain advance directives, including do-not-resuscitate (DNR) directives, signed independently by older people. This study explored the attitudes of older nursing home residents in Taiwan toward signing their own DNR directives.
  
  
  METHODS
  This study adopted purposive sampling and collected data through in-depth interviews. The data were analysed using qualitative inductive content analysis, and the study location was a nursing home in Eastern Taiwan.
  
  
  RESULTS
  A total of 11participants were recruited from a sample of 12 eligible participants. Most of the older residents in this study refused to make decisions independently regarding DNR directives. Content analysis of the interviews revealed four themes concerning refusing to sign DNR directives independently: not going against nature, accepting the results of cause and effect, viewing the family as a decision-making system, and practising self-effacement. Chinese cultural aspects, including Taoist, Buddhist, and Confucian philosophy, affected the autonomy of the older residents, and they relied on others to make decisions for them.
  
  
  CONCLUSIONS
  Professionals must respect this family-oriented decision-making thinking of older residents because it reflects personal choice. Otherwise, healthcare providers may play a mediating role in coordinating and communicating between older residents and their families regarding EOL-care-related concerns, replacing the traditional practice of holding a family meeting.
authors.affiliation: Department of Nursing, Tzu Chi University of Science and Technology, Hualien City, Taiwan.|Department of Nursing, National Taiwan University, Taipei City, Taiwan.
authors.forename: Hsin-Tzu Sophie
authors.initials: HT
authors.lastname: Lee
authors.affiliation: Department of Nursing, Tzu Chi University of Science and Technology, Hualien City, Taiwan.
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Cheng
authors.affiliation: Department of Nursing, National Taiwan University, Taipei City, Taiwan.
authors.forename: Yu-Tzu
authors.initials: YT
authors.lastname: Dai
authors.affiliation: Department of Nursing, National Taiwan University, Taipei City, Taiwan.
authors.forename: Mei
authors.initials: M
authors.lastname: Chang
authors.affiliation: Department of Nursing, National Taiwan University, Taipei City, Taiwan. 2011e3188@gmail.com.|Department of Nursing, College of Medicine, National Taiwan University, No. 1, Sec. 1, Jen-Ai Rd., Zhong zheng Dist., Taipei City, 100, Taiwan, R.O.C.. 2011e3188@gmail.com.
authors.forename: Wen-Yu
authors.initials: WY
authors.lastname: Hu
mesh_terms: D016223:Advance Directives / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D001290:Attitude; D003469:Culture; D003657:Decision Making; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008020:Life Support Care / Q000523:psychology*; D008297:Male; D016743:Mental Competency; D009735:Nursing Homes; D010865:Pilot Projects; D036301:Qualitative Research; D016414:Resuscitation Orders / Q000523:psychology; D013624:Taiwan
keywords: Advance directives (ADs); Cultural perspective; Decision-making; Do not resuscitate (DNR); End of life (EOL); Nursing home