Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
PLoS One. 2018 Nov 21;13(11):e0206550. doi: 10.1371/journal.pone.0206550. eCollection 2018.
In cancer care, do-not-resuscitate (DNR) decisions are made frequently; i.e., decisions not to start the heart in the event of a cardiac arrest. A DNR decision can be a complex process involving nurses and physicians with a wide variety of experiences and perspectives. Previous studies have shown different perceptions of the DNR decision process among nurses and physicians, e.g. concerning patient involvement and information. DNR decisions have also been reported to be unclear and documentation inconsistent.
The aim was to investigate how important and how likely to happen nurses and physicians considered various aspects of the DNR decision process, regarding participation, information and documentation, as well as which attributes they found most important in relation to DNR decisions.
A descriptive correlational study using a web survey was conducted, including 132 nurses and 84 physicians working in hematology and oncology.
Almost half of the respondents reported it not likely that the patient would be involved in the decision on DNR, and 21% found it unimportant to inform patients of the DNR decision. Further, 57% reported that providing information to the patient was important, but only 21% stated that this was likely to happen. There were differences between nurses and physicians, especially regarding participation by and information to patients and relatives. The attributes deemed most important for both nurses and physicians pertained more to medical viewpoints than to ethical values, but a difference was found, as nurses chose patient autonomy as the most important value, while physicians rated non-maleficence as the most important value in relation to DNR decisions.
Nurses and physicians need to be able to talk openly about their different perspectives on DNR decisions, so that they can develop a deeper understanding of the decisions, especially in cases where they disagree. They should also be aware that what they think is important is not always likely to happen. The organization needs to support such discussions through providing an environment that allows ethical discussions on regular basis. Patients and relatives will also benefit from receiving the same information from all caregivers.
在癌症护理中，经常会做出 不复苏（DNR）决定；即，在发生心脏骤停时不启动心脏的决定。DNR 决定可能是一个复杂的过程，涉及具有各种经验和观点的护士和医生。先前的研究表明，护士和医生对 DNR 决策过程有不同的看法，例如关于患者的参与和信息。也有报道称 DNR 决策不明确，记录不一致。
本研究旨在调查护士和医生认为 DNR 决策过程的哪些方面重要且可能发生，包括参与、信息和记录，以及他们认为与 DNR 决策相关的最重要的属性。
采用网络调查的描述性相关性研究，包括 132 名在血液科和肿瘤科工作的护士和 84 名医生。
近一半的受访者表示，患者不太可能参与 DNR 决策，21%的人认为向患者告知 DNR 决策不重要。此外，57%的人认为向患者提供信息很重要，但只有 21%的人表示这很可能发生。护士和医生之间存在差异，尤其是在患者和家属的参与和信息方面。护士和医生都认为最重要的属性更多地与医疗观点有关，而不是与伦理价值观有关，但存在差异，因为护士选择患者自主权作为最重要的价值观，而医生则将不伤害作为与 DNR 决策相关的最重要的价值观。
护士和医生需要能够就 DNR 决策的不同观点进行坦诚的讨论，以便更深入地了解决策，特别是在意见分歧的情况下。他们还应该意识到，他们认为重要的事情并不总是可能发生的。组织需要通过提供一个允许定期进行伦理讨论的环境来支持此类讨论。患者和家属也将受益于从所有护理人员那里获得相同的信息。
