Critical Care Nurses' Perceptions of Appropriate Care of the Patient With Orders Not to Resuscitate
Sherman, David A.
Heart and Lung. 1995 Jul-Aug; 24(4): 321-329.
OBJECTIVE: To determine critical care nurses' perceptions of appropriate care of patients with and without do-not-resuscitate (DNR) orders. DESIGN: Descriptive, cross-sectional. SETTING: Large, northeastern, metropolitan teaching hospital. SAMPLE: Eighty-seven staff nurses divided into DNR and non-DNR groups whose demographic characteristics were coincidentally similar. MEASURE: Responses to an original questionnaire. Questionnaires describing one of two hypothetical patients (DNR or non-DNR) were distributed to all available staff nurses working in adult intensive care units. RESULTS: After construct validity and internal consistency reliability were established (Cronbach's coefficient alpha = 0.84 for the physical subscale, 0.79 for the psychosocial), analysis of variance was used in the data analysis. Mean total scores were 60.7 for the DNR group and 69.6 for the non-DNR group (p = 0.0031). Mean scores on the physical subscale were 33.6 and 41.9 for the DNR and the non-DNR groups, respectively (p = 0.0032). Results on the psychosocial subscale showed no significant differences between the groups. Item analysis showed significant differences on weighing the patient (p = 0.0002), monitoring neurologic status (p = 0.0082), drawing blood cultures (p = 0.0094), checking vital signs (p = 0.0071), performing complete nursing assessments (p = 0.0179), and treating the patient in an intensive care unit (p = 0.0001). CONCLUSIONS: Compared with the patient without a DNR order, significantly lower levels of agreement were expressed with interventions involving monitoring for the patient with the DNR order. Agreement with placement of the patient with the DNR order in an intensive care unit may be seen to follow the same pattern. Education of caregivers and communication among them might help to clarify what may be ambiguous policies and orders.
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