DNR declaration - emergency medical system nurses’ opinions

• Authors: Mariusz Goniewicz , Patryk Rzońca , Jadwiga Klukow , Jakub Pawlikowski , Jarosław Sak , Krzysztof Goniewicz
• Languages of publication: EN

Abstracts

EN

Advance directive and other declarations of will made by patients in a case of mental illness still raise ethical and legal issues. In Poland there is no legal regulation, neither research about code of conduct in situation of do not attempt resuscitation. There are also not enough studies regarding Healthcare workers’ opinion about DNAR declaration (Do Not Attempt Resuscitation). The study is aimed at finding out emergency medical system nurses opinion on the subject of enforcing do not attempt resuscitation in situation of circulatory and respiratory arrest. Methods: The research was conducted by means of the diagnostic survey method applying a self - constructed questionnaire. The study was carried out among 82 (100%) nurses, from September to December 2011. Obtained information were analyzed statistically, Chi-square of independence with assumed p ≤ 0.05. level of significance was used for statistical analysis. Results: The study of the respondents’ opinion shows that 67% Healthcare employees think that DNAR declaration should be obligatory in Poland. Contrary opinion has 7.3% of respondents. In their opinion the decision to refrain from resuscitating should be made by attending physician − 46.3% and medical board − 29.3%. Information enclosed within DNAR declaration, in most of respondents’ opinion − 59.5%, should be only passed on in written form. Conclusions: Majority of respondents agree that patients have a right to refrain from resuscitating as a self − determination act. Respondents concur the introduction of DNAR declaration in Polish Healthcare system. In respondents’ opinion that decision should be required in written form and an attending physician should decide about its implementation, what violates the existing rule. The execution of living will declaration raises ethical issues. Additionally, it also appears as public/social problem. The last stage of incurable disease is given as justifiable circumstances of DNAR.

Keywords

EN

Ethics of resuscitation; Withdrawing and withholding life-sustaining therapy; DNR declaration; Nurses

• Publisher: De Gruyter Open
• Journal: Open Medicine
• Year: 2013
• Volume: 8
• Issue: 1
• Pages: 69-74

Dates

published

1 - 2 - 2013

online

8 - 12 - 2012

Contributors

author

Mariusz Goniewicz

• Emergency Medicine Unit, Medical University of Lublin, Chodzki 6 street, 20-093, Lublin, Poland

author

Patryk Rzońca

• Emergency Medicine Unit, Medical University of Lublin, Chodzki 6 street, 20-093, Lublin, Poland

author

Jadwiga Klukow

• Chair and Department of Management in Nursing, Medical University of Lublin, Lublin, Poland

author

Jakub Pawlikowski

• Department of Ethics and Human Philosophy, Medical University of Lublin, Lublin, Poland

author

Jarosław Sak

• Department of Ethics and Human Philosophy, Medical University of Lublin, Lublin, Poland

author

Krzysztof Goniewicz

• Emergency Medicine Unit, Medical University of Lublin, Chodzki 6 street, 20-093, Lublin, Poland

References

• [1] Atwood C, Eisenberg MS, Herlitz J, Rea TD., Incidence of EMS-treated out-of-hospital cardiac arrest in Europe, Resuscitation 2005, 67, 75–80 http://dx.doi.org/10.1016/j.resuscitation.2005.03.021[Crossref]
• [2] Baskett PJ, Steen PA, Bossaert L., European Resuscitation Council Guidelines for Resuscitation 2005, Section 8. The ethics of resuscitation and end-of-life decisions, Resuscitation 2005, 67, 71–80
• [3] Wichrowski M., Testament życia a odpowiedzialność moralno - prawna lekarza, W: Chańska W, Hartman J (red.), Bioetyka w zawodzie lekarza, Warszawa, Wyd. Wolters Klukwer, 2010, 29–39
• [4] Lippert FK, Raffay V, Georgiou M, Steen PA, Bossaert L., European Resuscitation Council Guidelines for Resuscitation 2010. Section 10. The ethics of resuscitation and end-of-life decisions, Resuscitation 2010, 81(10), 1445–1451 http://dx.doi.org/10.1016/j.resuscitation.2010.08.013[Crossref]
• [5] American Heart Association: Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC): medicolegal considerations and recommendations, JAMA 1974, 227, 864–866
• [6] Walker RM., DNR in the OR: resuscitation as an operative risk, JAMA 1991, 266, 2407–2412 http://dx.doi.org/10.1001/jama.1991.03470170095031[Crossref]
• [7] Truog RD., “Do-not-resuscitate” orders during anesthesia and surgery, Anesthesiology 1991, 74, 606–608 http://dx.doi.org/10.1097/00000542-199103000-00030[Crossref]
• [8] Aune S, Herlitz J, Bang A., Characteristics of patients who die in hospital with no attempt at resuscitation, Resuscitation, 2005, 65(3), 291–299 http://dx.doi.org/10.1016/j.resuscitation.2004.11.028[Crossref]
• [9] van Delden JJ, Löfmark R, Deliens L, Bosshard G, Norup M, Cecioni R, van der Heide A., Do-notresuscitate decisions in six European countries Crit Care Med. 2006; 34(6), 1686–1690
• [10] Mess E, Bienias T, Lisowska A, Jonek T, Twardek I, Mańkowska M, Chybicki M., Prawo pacjenta do godnej śmierci, Onkologia Polska, 2007, 10(4), 190–194
• [11] Szeroczyńska M., Czy pacjent ma prawo do śmierci? Standardy Medyczne, 2000, 2(5), 48–53
• [12] de Walden-Gałuszko K., U kresu. Opieka psychopaliatywna, czyli jak pomóc choremu, rodzinie i personelowi medycznemu środkami psychologicznymi, Gdańsk, Wyd. Medyczne MAKmed, 2000
• [13] Meisel A, Snyder L, Quill T., Seven legal barriers to end-of-life care: myths, realities, and grains of truth, JAMA, 2000, 284(19), 2495–2501 http://dx.doi.org/10.1001/jama.284.19.2495[Crossref]
• [14] Richter J, Eisemann MR., Attitudinal patterns determining decision-making in the treatment of the elderly: a comparison between physicians and nurses in Germany and Sweden, Intensiv Care Med, 2000, 26(9), 1326–1333 http://dx.doi.org/10.1007/s001340000602[Crossref]
• [15] Boguszewski R., Stosunek Polaków do śmierci. Komunikat z badań. Warszawa, Centrum Badania Opinii Społecznej, 2005, 10–12

Identifiers

DOI

10.2478/s11536-012-0092-y