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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