Table 1 Characteristics of the articles included in the systematic review (n = 10)
From: The worldwide investigating nurses’ attitudes towards do-not-resuscitate order: a review
Author’s name | Type of study | Year | Country of origin | Purpose of the study | Data collection instrument | Study setting | Main results |
|---|---|---|---|---|---|---|---|
Goniewicz et al. [28] | quantitative | 2011 | Poland | emergency nurses’ attitudes towards implementation of DNR order | questionnaire | hospital emergency ward | 67% of the respondents considered it necessary and obligatory to receive declarations or guidelines for DNR orders Nurses had adopted positive attitudes towards DNR order 7.3% of the participants stated that implementation of DNR msut be avoided 1. Most nurses believed that patients had the right to decide about DNR order 2. Existence of guidelines for DNR order is necessary 3. DNR order must be available in a written form 4. This procedure is considered as a social and moral problem |
Al Khalaileh [29] | quantitative | 2014 | Jordan | Nurse’s attitudes and experiences concerning DNR order in Jordan | questionnaire | state-run hospitals (n = 3) | 67% of the nurses recommended that patients’ families must be involved in making decisions about DNR order 81% of the nurses suggested a coded documentation system for nurses and physicians regarding decisions about DNR order 58% of the nurses agreed that there were standards and forms for DNR order 21% of the nurses agreed upon their involvement in decision-making about DNR order Finally, it was concluded that the nurses were willing to get engaged in DNR order and each hospital needed to develop a written DNR order directing individuals and preventing their confusion in this regard |
De Gendt et al. [30] | quantitative | 2000 | Belgium | Investigating nurses’ attitudes towards decision-making about DNR orders in geriatric departments departments | questionnaire | hospital | 74% of the nurses were involved in the process of DNR order 54% of the participants stated that DNA had not been implemented Nurses did not have a defined role in decision-making about DNR order. So, existence of standardized guidelines for decision-making about DNR seemed necessary |
Manias. [31] | quantitative | 1998 | Australia | Experiences and attitudes of Australian nurses towards decisions concerning DNR order | questionnaire | hospital and emergency ward (n = 6) | Nurses had positive attitudes towards implementing DNR order Nurses believed that patients’ families, patients, and nurses needed to be involved in decision-making regarding DNR order Physicians were only responsible for making decisions about DNR order Existence of standardized guidelines for decision-making about DNR seemed necessary |
Konishi [32] | quantitative | 1997 | Japan | Nurses’ attitudes towards DNR order policy in Japan | questionnaire | hospital and emergency ward (n = 6) | Almost all the nurses considered DNR order policy appropriate and supported it as an ideal process 85% of the nurses considered patients’ choices as decisive factors in implementation of DNR order 22% of the nurses put emphasis on DNR order 60% of the nurses stated that DNR order needed to be implemented as soon as possible Such a process could make nurses deal with difficult situations due to cultural and psychological factors |
Moghadesian et al. [33] | quantitative | 2014 | Iran | attitudes among Nursing students at Tabriz and Kurdistan Universities of Medical Sciences towards DNR order | questionnaire | Schools of Nursing in the cities of Tabriz and Kurdistan | Nursing students participating in the study had negative attitudes towards DNR order Students believed that they needed to learn much more about this procedure It seemed that teaching students about DNR order could change their attitudes in this domain |
Thibault-Prevost et al. [14] | quantitative | 1997 | Canada | Understanding ICU nurses’ attitudes towards DNR order | questionnaire | Nurses referring to College and Association of Registered Nurses of Alberta (CARNA) | Lack of instructions and legal guidelines for DNR orders Involvement of patients and families in making decisions about DNR order Nurse-physician communication and cooperation in the implementation of DNR order Existence of multilateral cooperation for making decisions to implement DNR order |
Rye Park et al. [34] | quantitative | 2008 | South Korea | ICU nurses’ perceptions and attitudes towards DNR orders | questionnaire | hospital and ICU | 96% of the participants considered the implementation of DNR order sometimes necessary 99.2% of the nurses considered explanations and descriptions of DNR order as a necessary issue 76.6% of the nurses agreed upon the implementation of DNR order 71% of the nurses considered patients’ preferences and wishes as the basis for implementation of DNR order 76.6% of the nurses agreed that decisions made about DNR orders needed to be based on guidelines for DNR order Only 22.2% of the nurses considered physicians’ votes as a basis for implementation of DNR order |
Pettersson et al. [35] | qualitative | 2014 | Sweden | Nurses’ attitudes towards DNR order in the Department of Hematology and Oncology | semi-structured interview | hospital and department of hematology and oncology | In order to provide good nursing care services in relation to DNR order, it was necessary to pay attention to the following issues: 1. Clarification and documentation of DNR order 2. Giving awareness to patients’ relatives and family members about DNR order and involvement of their decisions and opinions |
Nankundwa et al. [36] | qualitative | 2017 | Rwanda | Investigating ICU nurses’ experiences in Rwanda towards patients with DNR order | structured interview | hospital | Emotional anxiety: DNA order could induce emotional states in nurses and bring them into a difficult situation Prevention of good care: Existence of DNR order prevents good patient care services and it also affects numerous nursing activities Lack of guidelines for decision-making: in cases of implemented DNR order, only physicians had made such decisions Nurses believed that they would be allowed to decide about DNR order |