Background: A do-not resuscitate (DNR) order prohibits use of cardiopulmonary resuscitation (CPR) in the event of cardiopulmonary arrest. It should not be applied to any other interventions other than CPR. However, we reported that DNR status altered physicians’ decision making pertaining to use of non-CPR procedures in Japan (reported in ACP Japan chapter 2014, data in submission). We investigated the effect of DNR orders on nurses’ willingness to agree with physicians’ decision making in relation to performing non-cardiopulmonary resuscitation (CPR) and CPR procedures.
Methods:
A case-scenario-based questionnaire was administered to nurses, that included Case 1; 80 year old man of advanced cancer, Case 2; 80 year old man of advanced dementia, and Case3; an 80 year old man of non-advanced heart failure. The questions determined whether nurses would agree with physicians’ decision making to perform different non-CPR procedures and CPR procedures in the presence or absence of DNR orders. The numbers of non-CPR procedures each nurses would perform and the numbers of nurses who would perform each non-CPR and CPR procedure in the absence and presence of DNR orders were compared. PARTICIPANTS: Nurses from 3 Japanese municipal hospitals.
Results: We analyzed 286 out of 423 (69%) questionnaires. The age was 36 (29, 42) (medians (interquartile range)). Nurses would agree with physicians’ decision making to perform significantly fewer non-CPR procedures in the presence of DNR orders than in the absence of DNR orders for all 3 case scenarios : Case 1 100% (81%, 100%) (medians (interquartile range)) vs. 45 %( 27%, 63%) (p<0.001), Case 2 100 %( 81%, 100%) vs. 45% (20%, 63%) (p<0.001), Case 3 100% (88%, 100%) vs. 55% (33%, 75%) (p<0.001) in the absence and presence of DNR orders, respectively. Fewer nurses would agree with performing most of the non-CPR and CPR procedures in the presence of DNR orders than in the absence of DNR orders. Although few nurses would agree with performing CPR in the presence of DNR order, considerable number of nurses (approximately 35%) would not perform CPR procedure in case of cardiac arrest even in the absence of DNR order in all case scenarios.
Conclusions: DNR orders affect nurses’ decisions about performing non-CPR procedures. Some nurses would not perform CPR even in the absence of DNR orders. A consensus definition for DNR and full code orders should be developed in Japan, otherwise they may be harmful.