This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Robinson, F. Articles by Corrigan, M. Search for Related Content PubMed PubMed Citation Articles by Robinson, F. Articles by Corrigan, M. Social Bookmarking                         What's this?

Implementing a resuscitation policy for patients at the end of life in an acute hospital setting: qualitative study

Palliative Medicine, Sperrin Lakeland Trust, Tyrone County Hospital, Omagh, Co. Tyrone BT79 0AP, Northern Ireland, frobinson{at}slt.n-i.nhs.uk

Margaret Cupples

Department of General Practice, Queen’s University Belfast, Belfast

Mairead Corrigan

School of Medicine and Dentistry, Queen’s University Belfast, Belfast

Objective : To explore attitudes and experiences of doctors and nurses regarding cardiopulmonary resuscitation for patients with end stage illness in an acute hospital. Design : Qualitative study; thematic analysis of two audio-taped focus groups and four semi-structured interviews. Setting : Acute district hospital, Northern Ireland. Participants : Seven nurses and nine doctors; varying nationality, gender and years of professional experience; involved in cardiopulmonary resuscitation decision-making. Results : Participants reported different interpretations of resuscitation policy and of what do not attempt to resuscitate (DNAR) decisions meant in relation to practical care for patients. This confusion in translating policy into practice contributed to communication difficulties in initiating, documenting and implementing cardiopulmonary resuscitation decisions. Participants were aware of how clinical conditions could change and reported uncertainty in determining end stage illness; they expressed fears of potential consequences of DNAR decisions for patients' care. The more disease-centred approach of doctors to patients' management, compared to nurses' more patient-centred approach, contributed to inter-professional conflict within teams. Doctors identified training needs in applying resuscitation policy and ethical principles in `real life' and nurses identified a need for ongoing professional support, which was perceived as being less available to junior doctors. Personal relationships between staff and patients, cultural reluctance to address sensitive issues and local community expectations of relatives being involved in decisions added to policy implementation difficulties. Conclusions : The findings indicate a need for ongoing staff support and training in applying resuscitation policy to decisions for patients with end stage illness in an acute hospital. They support suggestions that reviews of local resuscitation policy and of national guidelines should be undertaken with openness and honesty regarding the goals, opportunities and difficulties involved in trying to deliver good end of life care in local settings. Palliative Medicine 2007; 21 : 305—312

Key Words: do not attempt resuscitation (DNAR) • end stage illness • inter-professional • policy • resuscitation decisions

Palliative Medicine, Vol. 21, No. 4, 305-312 (2007)
DOI: 10.1177/0269216307077817


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				F Tyrer, M Williams, L Feathers, C Faull, and I Baker Factors that influence decisions about cardiopulmonary resuscitation: the views of doctors and medical students Postgrad. Med. J., November 1, 2009; 85(1009): 564 - 568. [Abstract] [Full Text] [PDF]