DIFERENCES IN THE INTERPRETATION OF "DNR" AMONG PHYSICIANS AND NURSES ON INTERNAL MEDICINE WARDS.

Abstract

In 2005, in an attempt to regulate care for patients expected to live no longer than six months, Israel enacted the Dying Patient Law. The law sets forth in detail actions that should be performed to respect the patient's wishes, and also defines treatment to be given to patients who have directed that there be no heroic measures taken to prolong life. In some terminal cases, such as a patient who stops breathing or has a cardiac arrest, health care providers are instructed not to perform cardiopulmonary resuscitation (CPR). However, most healthcare providers are unsure of exactly what the definition of the Do-Not-Resuscitate order (DNR) means. The research goal was to identify opinions held by nurses and physicians as to the meaning of the DNR directive. The study was of a descriptive correlational design, based on a convenience sample of 61 physicians and nurses. The research instrument comprised a structured self administrative questionnaire. The results showed differences in the opinions of the health care staff as to which actions should be performed on patients who signed DNR directives, and which should not. While a majority of the respondents agreed that heart massage and ventilation were considered actions that should not be performed on DNR patients, other actions were found to be the subject of differences of opinion. For example, about half the respondents considered imaging tests and other tests as actions that should not be performed if a DNR order is in place. The study emphasizes the need to set multiple parameters and not only a single-dimension definition of DNR. Nurses and physicians should have regularly scheduled meetings to discuss the DNR order of specific patients.