title: Does resuscitation status affect decision making in a deteriorating patient? Results from a randomised vignette study.
abstract: OBJECTIVE
  The aim of this paper is to determine the influence of do not attempt cardiopulmonary resuscitation (DNACPR) orders and the Universal Form of Treatment Options ('UFTO': an alternative approach that contextualizes the resuscitation decision within an overall treatment plan) on nurses' decision making about a deteriorating patient.
  
  
  METHODS
  An online survey with a developing case scenario across three timeframes was used on 231 nurses from 10 National Health Service Trusts. Nurses were randomised into three groups: DNACPR, the UFTO and no-form. Statements were pooled into four subcategories: Increasing Monitoring, Escalating Concern, Initiating Treatments and Comfort Measures.
  
  
  RESULTS
  Reported decisions were different across the three groups. Nurses in the DNACPR group agreed or strongly agreed to initiate fewer intense nursing interventions than the UFTO and no-form groups (P < 0.001) overall and across subcategories of Increase Monitoring, Escalate Concern and Initiate Treatments (all P < 0.001). There was no difference between the UFTO and no-form groups overall (P = 0.795) or in the subcategories. No difference in Comfort Measures were observed (P = 0.201) between the three groups.
  
  
  CONCLUSIONS
  The presence of a DNACPR order appears to influence nurse decision making in a deteriorating patient vignette. Differences were not observed in the UFTO and no-form group. The UFTO may improve the way nurses modulate their behaviours towards critically ill patients with DNACPR status. More hospitals should consider adopting an approach where the resuscitation decisions are contextualised within overall goals of care.
authors.affiliation: Health Sciences, University of East Anglia, Norwich, Norfolk, UK.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Moffat
authors.affiliation: Department of Medicine, University of East Anglia, Norwich, Norfolk, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Skinner
authors.affiliation: Acute Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK.
authors.forename: Zoë
authors.initials: Z
authors.lastname: Fritz
mesh_terms: D000328:Adult; D016638:Critical Illness / Q000451:nursing*; D005260:Female; D006801:Humans; D007318:Inservice Training; D008297:Male; D008875:Middle Aged; D016414:Resuscitation Orders; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: clinical safety; healthcare; medical education