Henneman E A, Baird B, Bellamy P E, Faber L L, Oye R K
Department of Nursing, UCLA Medical Center 90024.
Am J Crit Care. 1994 Nov;3(6):467-72.
The effect of a do-not-resuscitate order on the standard of care of critically ill patients is of concern to practitioners, patients, and their families. Because "do not resuscitate" may be misconstrued to include more than "no cardiopulmonary resuscitation," it may influence the aggressiveness with which some patients are managed. Nurses play a central role in determining standards of care. Hence, confusion on their part as to the meaning of this term can have a significant impact on patient care.
To compare nurses' attitudes about standards of care for critically ill patients with and without a do-not-resuscitate order.
A quasi-experimental design using simulation measurement was used for this study.
Nurses reported that they would be significantly less likely to perform a variety of physiologic monitoring modalities and interventions for patients with a do-not-resuscitate order than for patients without such an order. Patients with a do-not-resuscitate order were more likely to receive psychosocial interventions including assessment of their spiritual needs and more flexible visiting practices.
Our findings suggest that "do-not-resuscitate" may be misinterpreted to include more than "no cardiopulmonary resuscitation" even if the patient is receiving aggressive medical management. Misinterpretation of orders not to resuscitate may be related to a variety of factors including lack of understanding about hospital policy and ethical and moral values of the staff. We suggest replacing orders such as "Do not resuscitate" with clearly defined resuscitation plans that are jointly determined by the multidisciplinary team, patient, and family.
“不要复苏”医嘱对重症患者护理标准的影响是从业者、患者及其家属所关注的。因为“不要复苏”可能被误解为包含了比“不进行心肺复苏”更多的内容，它可能会影响对某些患者的治疗积极性。护士在确定护理标准方面起着核心作用。因此，他们对该术语含义的混淆可能会对患者护理产生重大影响。
比较护士对有和没有“不要复苏”医嘱的重症患者护理标准的态度。
本研究采用模拟测量的准实验设计。
护士报告称，与没有“不要复苏”医嘱的患者相比，他们对有该医嘱的患者进行各种生理监测方式和干预的可能性要小得多。有“不要复苏”医嘱的患者更有可能接受心理社会干预，包括对其精神需求的评估和更灵活的探视安排。
我们的研究结果表明，即使患者正在接受积极的医疗管理，“不要复苏”也可能被误解为包含了比“不进行心肺复苏”更多的内容。对不复苏医嘱的误解可能与多种因素有关，包括对医院政策以及工作人员的伦理和道德价值观缺乏了解。我们建议用由多学科团队、患者和家属共同确定的明确复苏计划取代“不要复苏”等医嘱。
