Title:
Do not resuscitate status : knowledge, attitude and
Practice of critical care nurses in Palestine / by Nasser Khalaf Ali Dweib ; supervised by Dr. Asma Imam. حالة عدم الإنعاش : معرفة ومواقف وممارسات ممرضي/ات أقسام العنایة المكثفة في فلسطین
حالة عدم الإنعاش : معرفة ومواقف وممارسات ممرضي/ات أقسام العنایة المكثفة في فلسطین حالة عدم الإنعاش : معرفة ومواقف وممارسات ممرضي/ات أقسام العنایة المكثفة في فلسطین
Author:
Dweib, Nasser Khalaf Ali, author.
Imam, Asma, supervisor.
Al-Quds University (Jerusalem, Palestine). Faculty of Graduate studies. Faculty of Public Health.
General Notes:
Thesis (M. Sc. in Public Health)--Al-Quds University (Jerusalem, Palestine), Faculty of Graduate studies, Faculty of Public Health,
2018.
Includes bibliographical references and index.
Background :
Do not resuscitate (DNR) status is increasingly becoming a source of dilemma and moral
stress for critical care nurses in intensive care because it takes them away from their aim
which is health restoration. The study aimed to assess knowledge, attitude and practice of
nurses about DNR status in critical care units in Palestine.
Methods:
The cross-sectional descriptive design was used in this study to explore knowledge, attitude
and practice of critical care nurses about DNR status. The questionnaire was adopted from
Thibault-Prevost (1997), it consisted of 190 items, and it was used to study the subject in 6
main hospitals out of 50 hospitals in the West Bank.
Findings:
A total of 205 out of 393 nurses who participated in the study (Response rate of 52%). Of
the respondents, 51.4% were males and 48.6% were females, their mean age was 29 years,
76.8% had Bachelor degree and 85.9% held a staff nurse position. The mean practice period
as registered nurses and in critical care were 7.1 and 6.1 years respectively. The majority
practiced in medium size medical surgical ICUs and neonatal ICUs with percentage of
27.6% and 25.4% respectively.
Knowledge score about DNR was 6.23 on a scale 0-10; 95% CI [5.99, 6.47] which indicates
moderate knowledge. Seventy seven percent of respondents correctly defined DNR by its
legal intent. The majority of the respondents correctly didn’t link DNR with no care (84%),
78.9% of participants correctly indicated that a consent form is required for DNR and 70.3%
correctly indicated that they are legally obligated to initiate CPR in case of cardiopulmonary
arrest unless DNR is ordered. Significant differences in knowledge were present between
nurses who received post graduate course in critical care and who didn’t; in favor of who
received a course (p=0.002). Also significant differences were noted according to bed
capacity in favor of larger ICU capacity (p=0.039) and in working overtime (p=0.043).
i v
Most of respondents recognized that physicians, ethical committees, nurses and hospital
administrations should be involved in ensuring the existence of DNR policy. Most of the
respondents (75.1%) indicated that medical futility is the reason for DNR order. There were
significant differences in attitude toward DNR status between nurses who received post
graduate course in critical care and who didn’t; in favor of who didn’t received a course
(p=0.042) and larger ICU capacity (p=0.012). Factors that influenced DNR decision making
were categorized into three groups ordered by their influential effects as; family factors,
institutional factors and patient factors.
Only 43% of respondents answered that they had DNR policies in their institutions. More
than half of the them (54.6%) indicated that there was no change in the trends of DNR during
the last year. Most of respondents indicated that physicians, families and patients are actually
involved in decision making. Respondents reported that chronic neurological conditions and
chronic renal failure are the most chronic diagnoses that influence DNR decision, they also
indicated that life sustaining therapies following DNR order especially aggressive therapies
like Extracorporeal Membrane Oxygenation, Intra-aortic Balloon Pump, surgery, pacemaker
and hemodialysis are not frequently initiated. Respondents of this study reported that they
felt depressed, indifferent, anxious, frustrated and powerless when DNR order is issued.
They also indicated that patients with DNR died in intensive care unit or were transferred to
another ward to die.
Attitude toward DNR status, involvement in DNR situations and initiation of life sustaining
therapies following DNR order were found to be positively correlated to knowledge about
DNR status. On the other hand, attitude toward discontinuing life sustaining therapies
following DNR order was found to be negatively correlated to knowledge about DNR status.
Conclusion:
Based on findings of this study, nurses who work in critical care settings had moderate
knowledge about DNR status. Consensus about the need for written policies was indicated;
which, at national level, can regulate and facilitate nursing practice and reduce variations in
nursing and medical care surrounding DNR status. Involvement of nurses in the decision
making process regarding DNR status is a very important issue that should be addressed in
the Palestinian hospitals.
The electronic version is available in theses database \\ University of Jordan.
Includes abstracts in Arabic and English.
Subject:
Public Health Nursing -- Palestine
Nursing -- Psychological aspects.
Critical Care -- nurses' instruction
Critical Care Nursing -- Palestine
Hospitals -- Administration -- Palestine
Dissertation Note:
Thesis (M. Sc. in Public Health)--Al-Quds University (Jerusalem, Palestine), Faculty of Graduate studies, Faculty of Public Health,
2018.
Physical Description:
CD-ROM1 : PDF.
Publication Date:
2018.
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