Do-not-resuscitate decisions in the medical ICU; Comparing physician and nurse opinions

Arn H. Eliasson, Robin S. Howard, Kenneth G. Torrington, Thomas A Dillard, Yancy Y. Phillips

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Study objective: To determine how soon after admission to a medical ICU physicians and nurses decide that attempts at resuscitation are inappropriate and how frequently physicians and nurses disagree about do-not-resuscitate (DNR) decisions. Design: Prospective, opinion survey of care providers. Setting: Ten-bed adult medical ICU in a university-affiliated tertiary care referral hospital. Patients: Consecutive adult medical ICU admissions. Interventions: Over 10 months, physicians and nurses were surveyed independently every day regarding their opinions about DNR issues on each patient in the ICU. Measurements: ICU day when DNR order was deemed appropriate by either physicians or nurses. Results: Of 368 consecutive admissions, 84 (23%) patients were designated DNR during their ICU stay. In 6 of these 84 cases (7%), the responsible nurse did not agree that DNR orders were appropriate. In the remaining 78 patients designated DNR, the median time for physicians to recommend DNR (median, 1 day; range, 0 to 22 days) was not significantly different from the median time for nurses (median, 1 day; range, 0 to 13 days); (p=0.45). For the 284 patients not designated DNR, physicians and nurses both believed DNR was appropriate in 14 cases (5%), but a DNR order was not written five times (2%) because there was not time to do so and nine times (3%) because patient or family did not concur. Physicians and nurses disagreed about a DNR recommendation in 33 of the 284 patients not designated DNR (12%). Physicians were more likely to believe that DNR was appropriate than were nurses (p<0.0005), with physicians alone recommending DNR 29 times (10%) and nurses alone favoring DNR in four cases (1%). Conclusions: At our institution, recognition of DNR appropriateness by nurses and physicians occurs over a similar time frame. However, physicians are more likely to recommend DNR in cases of disagreement between nurses and physicians.

Original languageEnglish (US)
Pages (from-to)1106-1111
Number of pages6
JournalChest
Volume111
Issue number4
DOIs
StatePublished - Jan 1 1997
Externally publishedYes

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Nurses
Physicians
Resuscitation Orders
Tertiary Healthcare
Tertiary Care Centers
Resuscitation

Keywords

  • do-not-resuscitate orders
  • ethics
  • nurse opinions
  • physician opinions

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Eliasson, A. H., Howard, R. S., Torrington, K. G., Dillard, T. A., & Phillips, Y. Y. (1997). Do-not-resuscitate decisions in the medical ICU; Comparing physician and nurse opinions. Chest, 111(4), 1106-1111. https://doi.org/10.1378/chest.111.4.1106

Do-not-resuscitate decisions in the medical ICU; Comparing physician and nurse opinions. / Eliasson, Arn H.; Howard, Robin S.; Torrington, Kenneth G.; Dillard, Thomas A; Phillips, Yancy Y.

In: Chest, Vol. 111, No. 4, 01.01.1997, p. 1106-1111.

Research output: Contribution to journalArticle

Eliasson, AH, Howard, RS, Torrington, KG, Dillard, TA & Phillips, YY 1997, 'Do-not-resuscitate decisions in the medical ICU; Comparing physician and nurse opinions', Chest, vol. 111, no. 4, pp. 1106-1111. https://doi.org/10.1378/chest.111.4.1106
Eliasson AH, Howard RS, Torrington KG, Dillard TA, Phillips YY. Do-not-resuscitate decisions in the medical ICU; Comparing physician and nurse opinions. Chest. 1997 Jan 1;111(4):1106-1111. https://doi.org/10.1378/chest.111.4.1106
Eliasson, Arn H. ; Howard, Robin S. ; Torrington, Kenneth G. ; Dillard, Thomas A ; Phillips, Yancy Y. / Do-not-resuscitate decisions in the medical ICU; Comparing physician and nurse opinions. In: Chest. 1997 ; Vol. 111, No. 4. pp. 1106-1111.
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abstract = "Study objective: To determine how soon after admission to a medical ICU physicians and nurses decide that attempts at resuscitation are inappropriate and how frequently physicians and nurses disagree about do-not-resuscitate (DNR) decisions. Design: Prospective, opinion survey of care providers. Setting: Ten-bed adult medical ICU in a university-affiliated tertiary care referral hospital. Patients: Consecutive adult medical ICU admissions. Interventions: Over 10 months, physicians and nurses were surveyed independently every day regarding their opinions about DNR issues on each patient in the ICU. Measurements: ICU day when DNR order was deemed appropriate by either physicians or nurses. Results: Of 368 consecutive admissions, 84 (23{\%}) patients were designated DNR during their ICU stay. In 6 of these 84 cases (7{\%}), the responsible nurse did not agree that DNR orders were appropriate. In the remaining 78 patients designated DNR, the median time for physicians to recommend DNR (median, 1 day; range, 0 to 22 days) was not significantly different from the median time for nurses (median, 1 day; range, 0 to 13 days); (p=0.45). For the 284 patients not designated DNR, physicians and nurses both believed DNR was appropriate in 14 cases (5{\%}), but a DNR order was not written five times (2{\%}) because there was not time to do so and nine times (3{\%}) because patient or family did not concur. Physicians and nurses disagreed about a DNR recommendation in 33 of the 284 patients not designated DNR (12{\%}). Physicians were more likely to believe that DNR was appropriate than were nurses (p<0.0005), with physicians alone recommending DNR 29 times (10{\%}) and nurses alone favoring DNR in four cases (1{\%}). Conclusions: At our institution, recognition of DNR appropriateness by nurses and physicians occurs over a similar time frame. However, physicians are more likely to recommend DNR in cases of disagreement between nurses and physicians.",
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