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Understanding nursing care of older adults with ‘do not resuscitate’ orders in acute care Saran, Navjot

Abstract

In recent years, the use of DNR orders in acute care has been increasing, especially for older adults. Unfortunately, many nurses misinterpret the definition of DNR and this knowledge gap has implications for how care is provided for older adults. This lack of understanding of meaning as well as care practices associated with DNR designations is a cause for concern, as it has practical, ethical and moral implications for patient care. Nursing practice in relation to DNR orders can have permanent consequences on the health outcomes of patients and it is therefore essential to acknowledge and recognize the personal and contextual forces that shape the care of older adults with DNR orders in acute care so that ethical practice be supported. This interpretive descriptive study explored nursing care of older adults with DNR designations on medical/surgical units in acute care and also identified facilitators and barriers towards their ethical practice in relation to DNR orders. Data were collected through semi-structured interviews with Registered Nurses (N=8) employed on acute medical units at an urban community hospital in British Columbia. Audiotaped interviews were transcribed and analyzed using an interpretive descriptive approach. Five main themes and 19 subthemes were identified. The Registered Nurses indicated the need to clarify the interpretation of DNR in clinical practice and acknowledged the complexities of the DNR decision making process. The nurses emphasized that patients were given safe and ethical care irrespective of code status however nursing interventions were prioritized for full code patients. Nurses reported complex barriers to their ethical practice in relation to DNR order such as unrealistic physician orders, the lack of time in conjunction with the lack of knowledge of the patient’s wishes and highly directive and anxious family members. Facilitating factors towards nursing care of DNR designated patients comprised of education which was viewed as essential in improving care practices and assessment skills for dying DNR designated patients. Team work, higher nurse to patient ratio and support were also associated with propelling better nursing care and practice. The themes have implications for nursing practice, administration, education, and research.

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Attribution-NonCommercial-NoDerivs 2.5 Canada

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