TY  - JOUR
T1  - Nurses’ Decision-Making in Cardiopulmonary Resuscitation for Deceased Inpatients Without DNR Orders: Ethical Considerations and Defensive Practice
A1  - Thao Nguyen
A1  - Minh Tran
A1  - Lan Pham
JF  - Asian Journal of Ethics in Health and Medicine
JO  - Asian J Ethics Health Med
SN  - 3108-5059
Y1  - 2021
VL  - 1
IS  - 1
DO  - 10.51847/K0nTCfJ9Y7
SP  - 139
EP  - 151
N2  - Nurses in hospital settings are frequently the first to notice when a patient experiences cardiorespiratory arrest and must make prompt decisions about whether to call a CODE BLUE and initiate cardiopulmonary resuscitation (CPR). In the Australian context, there is no legal or policy requirement to perform CPR when a patient shows clear and irreversible signs of death. Delivering CPR in circumstances where it cannot benefit the patient presents complex ethical and professional dilemmas. This study, grounded in empirical ethics, sought to examine how hospital nurses make decisions, perceive, and experience the initiation of CPR for patients who are clearly deceased but do not have an existing Do-Not-Resuscitate (DNR) directive. The research was conducted as a cross-sectional, descriptive survey across multiple hospital sites from October two thousand twenty-three to April two thousand twenty-four. Inpatient nurses were asked to respond to two hypothetical cases in which patients exhibited no detectable signs of life: one involved Mr. D, an eighty-four-year-old man with cancer, and the other Mr. G, a thirty-five-year-old man following a motor vehicle collision. All nurses working in inpatient units were eligible to participate. The collected data were analyzed using a combination of descriptive statistics, Chi-square or Fisher’s exact tests, the McNemar test, and binomial logistic regression. The survey was completed by a total of five hundred thirty-one nurses. Regarding Mr. D, three hundred twenty-four nurses, representing sixty-one point five percent, reported they would call a CODE BLUE, while one hundred twenty-seven nurses, or twenty-four point one percent, indicated they would perform limited CPR. Only seventy-six nurses, equivalent to fourteen point four percent, stated they would confirm death. In contrast, for Mr. G, the majority—four hundred ninety-two nurses, or ninety-three point nine percent—would call a CODE BLUE; twenty-three nurses, or four point four percent, would perform limited CPR, and nine nurses, or one point seven percent, would confirm death. Nurses identified several key reasons for initiating a CODE BLUE: adherence to hospital policy, legal obligations, absence of a DNR order, and following their training. The majority of nurses reported they would initiate CPR in patients exhibiting unmistakable signs of death when no DNR order was in place. This tendency appears to stem from gaps in knowledge or misunderstanding of legal requirements, institutional policies, or the misapplication of professional norms. These findings raise significant questions about the factors shaping nurses’ comprehension of and engagement with CPR. They also underscore ethical concerns surrounding the care of patients at the end of life and highlight the importance of examining ethical practice, professional agency, and accountability. Furthermore, the results support the need for reviewing policies, clinical practices, and educational initiatives related to ethical decision-making and end-of-life care.
UR  - https://smerpub.com/article/nurses-decision-making-in-cardiopulmonary-resuscitation-for-deceased-inpatients-without-dnr-orders-blzl2kc5lv8qz87
ER  -