An Exploration of Certified Registered Nurse Anesthetists’ Education, Interpretation, and Management of Do-Not-Resuscitate Orders in the Perioperative Setting

Abstract

Required reconsideration or review of do-not-resuscitate (DNR) orders in the perioperative period is now recommended by the American Association of Nurse Anesthetists (AANA), American Society of Anesthesiologists (ASA), American College of Surgeons (ACS), and Association of periOperative Registered Nurses (AORN) in lieu of automatic suspension of the DNR. This study used an exploratory descriptive design to ascertain types of Certified Registered Nurse Anesthetist (CRNA) training on required reconsideration and management of patients with advance directives. A survey originally developed in a 2000 study by Coopmans and Gries was amended and sent to a random sample of CRNAs in the United States with 207 returned responses. The majority of CRNAs surveyed (63.5%) initially reported unfamiliarity with the concept of required reconsideration. Familiarity with required reconsideration was associated with refusal to care for patients with active DNR orders in the future (P = .004). Education or training on required reconsideration is uncommon and often informal in nature—when present, however, it is associated with increased discussion of advance directives with a patient preoperatively (P