Tohoku J. Exp. Med., 2020 January, 250(1)

Absence of Relatives Impairs the Approach of Nurses to Cardiopulmonary Resuscitation in Non-Cancer Elderly Patients without a Do-Not-Attempt-Resuscitation Order: A Vignette-Based Questionnaire Study

ASAKA HIGUCHI,¹ MORIHITO TAKITA,¹ AZUSA YOSHII,² TOMOKO AKIYAMA,³ TSUYOSHI NEMOTO,⁴ RITSUKO NAKAHIRA,⁵ TOSHIHIRO NAKAJIMA,⁶ HIROKI FUKAHORI,⁷ MASAHARU TSUBOKURA^8,9 and RIKA IGARASHI²

¹Medical Governance Research Institute, Tokyo, Japan
²Department of Nursing, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan
³Department of Nursing, Kashima Kosei Hospital, Minamisoma, Fukushima, Japan
⁴Department of Home Care, Kashima Kosei Hospital, Minamisoma, Fukushima, Japan
⁵Department of Nursing, Daiichi Rehabilitation Hospital, Kochi, Kochi, Japan
⁶Bayside Misato Medical Center, Kochi, Kochi, Japan
⁷Faculty of Nursing and Medical Care, Keio University, Fujisawa, Kanagawa, Japan
⁸Department of Public Health, School of Medicine, Fukushima Medical University, Fukushima, Fukushima, Japan
⁹Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan

A Do-Not-Attempt-Resuscitation (DNAR) order solely precludes performing cardiopulmonary resuscitation (CPR) following cardiopulmonary arrest. A patient's personal status is known to influence a range of clinical practices, not only CPR, when a DNAR order is given. We assessed whether the absence of supporting relatives or a diagnosis of dementia can influence nurses' perceptions of clinical practices for elderly patients with non-malignant and chronic diseases. A vignette-based questionnaire was used to evaluate nurses' beliefs both before and after issuance of a DNAR order. Three vignettes were developed: the control vignette described an 85-year-old woman with repeated heart failure, the second and third incorporated a lack of relatives and a dementia diagnosis, respectively. The survey assessed the approach of nurses to 10 routine medical procedures, including CPR, clinical laboratory testing and nursing care, using a 5-base Likert-scale, for six vignette scenarios. A questionnaire was completed by 186 nurses (64% response). The pre-DNAR non-relative vignette showed significantly lower scores for CPR, indicating a deterioration in willingness to perform CPR, compared to the pre-DNAR control (median [interquartile]; 3 [2-4] and 4 [3-4] in the non-relative and control vignettes, respectively, p < 0.001). No significant differences were observed between the dementia and control vignettes. Absence of contactable relatives and resultant lack of communication can diminish the perception of nurses regarding the provision of CPR, even when a DNAR does not exist. This result suggests a necessity for comprehensive training all medical staff about issuance of DNAR orders and what care should be provided thereafter.

Keywords —— chronic disease; dementia; do-not-attempt-resuscitation order; family relationship; patient autonomy

© 2020 Tohoku University Medical Press

===============================

Tohoku J. Exp. Med., 2020, 250, 71-78

Correspondence: Asaka Higuchi, R.N., P.H.N., M.S.N., Medical Governance Research Institute, 2-12-13 Takanawa, Minato-ku, Tokyo 108-0074, Japan.

e-mail: a.higuchi1025@gmail.com