Support of patient autonomy in the do not resuscitate decision

Article Abstract:

When is cardiopulmonary resuscitation (CPR) appropriate, and when should the ''do not resuscitate'' (DNR) order be given? Who should give the order? These questions are of great ethical concern to patients, families, physicians and nurses, and they hinge on whether CPR will add to life, or merely prolong dying. This study explored nurses' beliefs about support of the patient's wishes regarding the DNR decision, and, through a set of four hypothetical cases, determined nurses' beliefs about the appropriate person to make the decision. Nurses were asked who should make the decision in each case, and then who would make the decision in the unit where they were currently working. In three of the four cases, the person chosen as the most appropriate to make the decision was not the one the nurses said would make the decision where they worked, posing an ethical dilemma. Medical ethics theory regarding human interaction, and interaction between society and professionals, and between the individual health professional and the patient is discussed. Competence of the patient, whether the patient's beliefs and values are known, and the availability of next of kin or physician and other health care providers all play a role in making this decision. Nurses, because they have greater contact with patients, are often more aware of a patient's wishes than the attending physician, and the nurse should, under certain circumstances, be able to write a DNR order. Although the patient is best able to decide, research shows that the patient is often not involved in the decision. Institutional policies and legal guidelines must be examined and perhaps changed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ethical aspects, Resuscitation

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Attitudes and knowledge of nurses regarding organ procurement

Article Abstract:

The first kidney transplant took place over 35 years ago, and since then great progress has taken place in organ transplantation. However, transplantation is still limited by the availability of organs, and thousands of Americans remain on waiting lists for kidneys, hearts, lungs, livers, and other organs. In spite of this, many candidates for donation are not identified or organs are not donated for other reasons. This study, carried out at a university-affiliated hospital, explored attitudes of 60 nurses toward organ donation. It was found that 94 percent of the nurses surveyed approved of organ donation, but only half had indicated a desire to donate their own organs through their driver's license, and only two thirds would encourage their own family members to donate organs. Just over two thirds would actively seek to have patients in their care donate organs. Nurses working in the surgical intensive care unit (SICU) were more in favor of organ donation, perhaps because these nurses were more likely to care for potential organ donors, and felt bettered prepared for it. Black and Asian nurses differed from white nurses in their attitudes, but how they differed is not made clear; the number of black, Asian, and Hispanic nurses was too small for any conclusions to be drawn. Nurses with more experience with and knowledge of organ donation expressed more favorable attitudes, indicating a likely area where educational intervention can play an important role. (Consumer Summary produced by Reliance Medical Information, Inc.)

Donation of organs, tissues, etc., Tissue donation

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Management of the patient with do not resuscitate status: compassion and cost containment

Article Abstract:

The patient whose status is stipulated as 'do not resuscitate' (DNR) requires special consideration from all care givers. In addition to the clinical care required for their illnesses, DNR patients require special attention to their physical, psychological and spiritual needs. A Comprehensive Supportive Care Team (CSCT) was developed at the Detroit Receiving Hospital to provide the multidisciplinary care required to meet this spectrum of patient needs. The CSCT consisted of a clinical nurse specialist, staff physician, social worker, respiratory therapist, and the patient's primary care nurse. Costs of care were estimated by values determined by the Therapeutic Intervention Scoring System (TISS). The impact of the CSCT group on the cost of care for 131 patients with DNR status was evaluated from December 1988 to December 1989 using TISS values. The costs of CSCT care for patients with DNR status were compared with those of care provided by the intensive care unit (ICU) staff; the costs of care by the CSCT were found to be substantially reduced. Elements that contributed to reduced costs were general ward care, the multidisciplinary approach, decreased therapeutic interventions, and consistency of care. Other costs related to space and staff utilization, staff retention, and family expense further reduced the cost of care for the patients with DNR status. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Management, Economic aspects, Terminal care, CPR (First aid), Cardiopulmonary resuscitation

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