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Do-not-attempt-resuscitation (DNAR) orders: understanding and interpretation of their use in the hospitalised patient in Ireland. A brief report
  1. Helen O’Brien1,2,
  2. Siobhan Scarlett1,2,
  3. Anne Brady3,
  4. Kieran Harkin4,
  5. Rose Anne Kenny1,2,
  6. Jeanne Moriarty5
  1. 1Department of Medical Gerontology, Mercer’s Institute for Successful Ageing, St. James’s Hospital, Dublin, Ireland
  2. 2Trinity College Dublin, Dublin, Ireland
  3. 3Department of Nursing, Resuscitation Officer, St. James’s Hospital, Dublin, Ireland
  4. 4Inchicore Family Doctors, Primary Care Centre, St. Michaels Estate, Dublin, Ireland
  5. 5Department of Anaesthesia, St. James’s Hospital, Dublin, Ireland
  1. Correspondence to Dr. Helen O’Brien, Department of Medical Gerontology, Mercer’s Institute for Successful Ageing, St. James’s Hospital, Dublin, Ireland; 1h.obrien1{at}gmail.com

Abstract

Following the introduction of do-not-resuscitate (DNR) orders in the 1970s, there was widespread misinterpretation of the term among healthcare professionals. In this brief report, we present findings from a survey of healthcare professionals. Our aim was to examine current understanding of the term do-not-attempt-resuscitate (DNAR), decision-making surrounding DNAR and awareness of current guidelines. The survey was distributed to doctors and nurses in a university teaching hospital and affiliated primary care physicians in Dublin via email and by hard copy at educational meetings from July to December 2014. A total of 519 completed the survey. The response rate in the hospital doctors group was 35.5% (187/527), 19.8% (292/1477) in the nurses group but 68.8% (150/218) in the specialist nurses group and 40% (40/100) in the primary care physician group.

Alarmingly, our results demonstrate that 26.8% of staff nurses and 30% of primary care physicians surveyed believed that a patient with a DNAR order could not receive any/at least one of a list of simple treatments including antibiotics, physiotherapy, intravenous fluids, pain relief, oxygen, nasogastric feeding or airway suctioning, which were higher percentages compared to the other hospital doctors and experienced nurses groups with statistically significant differences (p<0.001). Furthermore, a higher percentage of staff nurses (26.8%) and primary care physicians (22.5%) believed that a patient with a DNAR order could not be referred to hospital from home/a nursing home, when compared with other healthcare groups (p<0.001). Our findings highlight continued misunderstanding and over-interpretation of DNAR orders. Further collaboration and information is required for meaningful Advance Care Plans.

  • end-of-life
  • decision-making
  • clinical ethics
  • right to healthcare
  • aged

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Footnotes

  • Contributors HOB is the corresponding author and is responsible for the conception and design of the work; the acquisition, analysis and interpretation of the data; drafting the work and revising it critically for important intellectual content; gave final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity of the work are appropriately investigated and resolved. SS specifically assisted in data coding, data management, data analysis and graphical presentation of results. AB was responsible for the conception and design of the work and data collection. KH assisted in data collection. RAK assisted in drafting the work and revising it critically for intellectual content. JM assisted in the conception and design of the work, analysis and interpretation of the data, drafting the work and revising it critically for important intellectual content.

  • Funding Financial support for this study was provided by Trinity College Dublin.

  • Competing interests None declared.

  • Ethics approval Tallaght, St. James’s Hospital Ethics Committee, and Nursing Research Access Committee

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional results are available as online supplementary material.

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