Nurses' attitudes concerning the appropriateness of do not resuscitate orders

The purpose of this descriptive study was to examine the Influence of various patient factors on nurses' attitudes concerning the appropriateness of "Do Not Resuscitate" (DNR) orders. The subjects were 149 registered staff nurses employed at 2 medical centers In Knoxville, Tennessee. Nurses' attitudes were examined by their responses to paired clinical vignettes. Each pair of vignettes contained comparable clinical Information with the exception of a single factor that potentially could Influence a decision to withhold OPR. A Likert Scale was utilized for all vignettes to measure attitudes concerning the appropriateness of a DNR order.

The Instruments used in this study Included the Job Involvement Scale (Lodahl & Kejner, 1965), the DNR Questionnaire (Farber, Bowman, Major & Green, 1984), and a demographic questionnaire developed by the researcher. Statistical analyses Included paired t-tests. Repeated Measures Analysis of Variance (a General Linear Model was used for unbalanced designs), and the Tukey's Studentlzed Range Test. Frequency distributions and measures of central tendency were also calculated.

The results of this study Indicated that the age of the patient had a significant Influence (P <0.05) on nurses' attitudes toward a DNR order. As the age of the patient In the vignettes Increased, the respondent was more likely to agree with a DNR order. The study also found that DNR orders were considered appropriate for residents of nursing homes, and patients with terminal cancer and dementia secondary to Alzheimer's disease.

The patient factor of drug dependence did not Increase the acceptance of a DNR order. Demographic and psychosocial characteristics of the nurse did not Influence DNR acceptance.

This study demonstrated that a patient's mental status, and blomedlcal and psychosoclal factors had a significant Impact (P ≤ 0.05) on nurses' attitudes toward a DNR order and Its appropriateness for a particular patient. Implications for nursing Interventions and for future research were discussed.