De Gendt Cindy, Bilsen Johan, Vander Stichele Robert, Van Den Noortgate Nele, Lambert Margareta, Deliens Luc
End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
J Adv Nurs. 2007 Feb;57(4):404-9. doi: 10.1111/j.1365-2648.2007.04090.x.
This paper reports the involvement of nurses in 'do not resuscitate' decision-making on acute elder care wards and their adherence to such decisions in the case of an actual cardiopulmonary arrest.
Previous literature showed that nurses are involved in half or less than half of 'do not resuscitate' decisions in hospitals, but their involvement in this decision-making on acute elder care wards in particular has not been investigated.
A questionnaire was sent in 2002 to the head nurses of all acute elder care wards in Flanders, Belgium (n = 94). They were asked whether nurses had been involved in the last 'do not resuscitate' decision-making process on their ward and whether nurses 'never', 'rarely', 'sometimes', 'often' or 'always' started resuscitation in case of cardiopulmonary arrest of patients with 'do not resuscitate' status and of those without.
The response rate was 86.2% (n = 81). In 74.7% of the last 'do not resuscitate' decisions on acute elder care wards in Flanders, a nurse was involved in the decision-making process. For patients with 'do not resuscitate' status, 54.3% of respondents reported that cardiopulmonary resuscitation was 'never' started on their ward, 'rarely' on 39.5% and 'sometimes' on 6.2%. For patients without 'do not resuscitate' status, nurses started cardiopulmonary resuscitation 'rarely' or 'sometimes' on 22.2% of all wards, and 'often' or 'always' on 77.8%.
To make appropriate 'do not resuscitate' decisions and to avoid rash decision-making in cases of actual cardiopulmonary arrest, nurses should be involved early in 'do not resuscitate' decision-making. If institutional 'do not resuscitate' guidelines were to stress more clearly the important role of nurses in all kinds of end-of-life decisions, this might improve the 'do not resuscitate' decision-making process.
本文报告了护士在急性老年护理病房参与“不进行心肺复苏”决策的情况，以及在实际发生心肺骤停时他们对这些决策的遵守情况。
以往文献表明，护士参与医院“不进行心肺复苏”决策的比例为一半或不到一半，但他们在急性老年护理病房的这一决策过程中的参与情况尤其未得到调查。
2002年向比利时弗拉芒地区所有急性老年护理病房的护士长（n = 94）发放了一份问卷。询问她们护士是否参与了其病房上一次“不进行心肺复苏”的决策过程，以及对于有“不进行心肺复苏”状态的患者和没有该状态的患者在发生心肺骤停时，护士是“从不”“很少”“有时”“经常”还是“总是”开始进行复苏。
回复率为86.2%（n = 81）。在弗拉芒地区急性老年护理病房上一次“不进行心肺复苏”决策中，74.7%的决策过程有护士参与。对于有“不进行心肺复苏”状态的患者，54.3%的受访者表示其病房“从不”开始进行心肺复苏，39.5%“很少”开始，6.2%“有时”开始。对于没有“不进行心肺复苏”状态的患者，在所有病房中，22.2%的护士“很少”或“有时”开始进行心肺复苏，77.8%“经常”或“总是”开始。
为了做出恰当的“不进行心肺复苏”决策，并避免在实际发生心肺骤停时做出草率决策，护士应尽早参与“不进行心肺复苏”的决策过程。如果机构的“不进行心肺复苏”指南能更明确地强调护士在各类临终决策中的重要作用，这可能会改善“不进行心肺复苏”的决策过程。
