An ethical problem facing nurses: The support of patient autonomy in the Do Not Resuscitate decision

Date

1986-05

Authors

Ott, Barbara

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Abstract

The purpose of this study was to examine critical-care nurses beliefs concerning the support of patient autonomy in the Do Not Resuscitate (DNR) decision in patients whose health condition was irreversible and terminal.

The population for the study consisted of registered nurses who were active members of the American Association of Critical-Care Nurses (AACN). The instrument was mailed to 500 randomly selected members of AACN. The study sample consisted of the 251 nurses who returned the completed questionnaires.

The instrument was developed by the investigator and included four hypothetical cases involving the Do Not Resuscitate decision. Following each hypothetical case, the subject was asked to select the agent (patient, family, physician, or nurse) who would most likely support patient autonomy in the DNR decision. The subjects were then asked to select the agent (patient, family, physician, or nurse) whose opinion would actually be regarded as most appropriate for making the DNR decision if this case were to present on the clinical unit where the nurse was employed. Questions designed to describe the sample of nurses and their experience with the Do Not Resuscitate decision followed.

In each of the four hypothetical cases presented the nurses selected an agent as best able to support patient autonomy. Their choices varied from case to case, depending upon the different aspects of the cases; however, there was general agreement among the nurses as to the most appropriate agent to make the Do Not Resuscitate decision in each case. When asked whose opinion would actually be regarded as most appropriate to make the DNR decision if the case were to present on the units, the nurses responded most frequently that the physician's opinion would be regarded as most appropriate for making the DNR decision, regardless of the agent selected as best able to support patient autonomy in the case situation (p = <0.001). An ethical conflict concerning the DNR decision appears to exist for the majority of the nurses in this study.

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Keywords

Decision, Nurses, Case, Patient, Support, Autonomy

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