CRITICAL CARE NURSES PERCEPTIONS OF APPROPRIATE CARE OF THE PATIENT WITH ORDERS NOT TO RESUSCITATE

Objective: To determine critical care nurses' perceptions of appropria te care of patients with and without do-not-resuscitate (DNR) orders. Design: Descriptive, cross-sectional. Setting: Large, northeastern, me tropolitan teaching hospital. Sample: Eighty-seven staff nurses divide d into DNR and non-DNR groups whose demographic characteristics were c oincidentally similar. Measure: Responses to an original questionnaire . Questionnaires describing one of two hypothetical patients (DNR or n on-DNR) were distributed to all available staff nurses working in adul t intensive care units. Results: After construct validity and internal consistency reliability were established (Cronbach's coefficient alph a = 0.84 for the physical subscale, 0.79 for the psychosocial), analys is of variance was used in the data analysis. Mean total scores were 6 0.7 for the DNR group and 69.6 for the non-DNR group (p = 0.0031). Mea n scores on the physical subscale were 33.6 and 41.9 for the DNR and t he non-DNR groups, respectively (p = 0.0032). Results on the psychosoc ial subscale showed no significant differences between the groups. Ite m analysis showed significant differences on weighing the patient (p = 0.0002), monitoring neurologic status (p = 0.0082), drawing blood cul tures (p = 0.0094), checking vital signs (p = 0.0071), performing comp lete nursing assessments (p = 0.0179), and treating the patient in an intensive care unit (p = 0.0001). Conclusions: Compared with the patie nt without a DNR order, significantly lower levels of agreement were e xpressed with interventions involving monitoring for the patient with the DNR order. Agreement with placement of the patient with the DNR or der in an intensive care unit may be seen to follow the same pattern. Education of caregivers and communication among them might help to cla rify what may be ambiguous policies and orders.