Ph.D. Student in Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran.
Department of Emergency Medicine, School of Para medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Ethiop J Health Sci. 2022 Mar;32(2):413-422. doi: 10.4314/ejhs.v32i2.22.
Making appropriate decisions for cardiopulmonary resuscitation (CPR) is very challenging for healthcare providers. This study aimed to evaluate knowledge, attitude, and decision making about do-not-resuscitate (DNR) and termination of resuscitation (ToR) among nurses in the resuscitation team.
This descriptive cross-sectional study was conducted in April-September 2020. Participants were 128 nurses from the CPR teams of two hospitals in Kermanshah and Hamedan, Iran. A valid and reliable researcher-made instrument was used for data collection. Data were analyzed using the Chi-square, Fisher's exact, and Mann-Whitney U tests, the Spearman's correlation analysis, and the logistic and rank regression analyses.
Only 22.7% and 37.5% of participants had adequate knowledge about ToR and DNR. The significant predictor of DNR and ToR knowledge was educational level and the significant predictors of decision making for CPR were educational level, gender, and history of receiving CPR-related education (P<0.05). When facing a cardiac arrest and indication of DNR or ToR, 12.5% of participants reported that they would not start CPR, 21.5% of them reported that they would terminate CPR, and 14.8% of them reported that they would perform slow code. The DNR decision had significant relationship with educational level, DNR knowledge, and ToR knowledge (P< 0.05), while the ToR decision had significant relationship with educational level and ToR knowledge (P<0.05).
Nurses' limited DNR and ToR knowledge and physicians' conflicting orders and documentation can cause ethical challenges for nurses. Clear guidelines for DNR orders or TOR is necessary for nurses, in order to prevent any potential confusion, legal or psychosocial issues and concerns surrounding CPR and improve their involvement in CPR decision making process.
对于医疗保健提供者来说，做出适当的心肺复苏（CPR）决策极具挑战性。本研究旨在评估复苏团队护士对“不复苏”（DNR）和停止复苏（ToR）的知识、态度和决策。
这是一项 2020 年 4 月至 9 月进行的描述性横断面研究。参与者是来自伊朗克尔曼沙阿和哈马丹两家医院复苏团队的 128 名护士。使用经过验证和可靠的研究者制作的仪器收集数据。使用卡方检验、Fisher 确切检验和曼-惠特尼 U 检验、Spearman 相关分析以及逻辑回归和秩回归分析来分析数据。
只有 22.7%和 37.5%的参与者对 ToR 和 DNR 有足够的了解。DNR 和 ToR 知识的显著预测因子是教育水平，而 CPR 决策的显著预测因子是教育水平、性别和接受 CPR 相关教育的历史（P<0.05）。当面临心脏骤停和 DNR 或 ToR 指征时，12.5%的参与者表示他们不会开始 CPR，21.5%的参与者表示他们将终止 CPR，14.8%的参与者表示他们将进行缓慢编码。DNR 决策与教育水平、DNR 知识和 ToR 知识显著相关（P<0.05），而 ToR 决策与教育水平和 ToR 知识显著相关（P<0.05）。
护士对 DNR 和 ToR 的知识有限，以及医生的命令和文件相互冲突，这可能会给护士带来伦理挑战。为了防止任何潜在的混乱、法律或社会心理问题以及围绕 CPR 的担忧，并改善他们对 CPR 决策过程的参与，有必要为护士制定明确的 DNR 命令或 ToR 指南。
