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Lived experiences of nurses in the care of patients with do-not-resuscitate order.

Author

Aldie  Cabalan

Related Institution

College of Nursing - Cebu Normal University

Publication Information

Publication Type
Thesis/Dissertations
Thesis Degree
MS
Specialization
Medical-Surgical Nursing
Publication Date
March 2011

Abstract

ABSTRACT 


Statement of the Problem. The study wishes to explore the lived experiences of nurses caring for a patient with a Do-Not-Resuscitate (DNR) order in the year 2010 among tertiary hospitals in Cebu City. Specifically, it wants to probe and seek answers on the following questions: (1) how do intensive care unit nurses view their patient before and after a do-not-resuscitate (DNR) order in terms of the physical, mental, social and the spiritual being; (2) how do ICU nurses describe their caring attitude towards the client after the DNR order was prescribed; (3) how do they describe their feelings regarding the possible loss of a patient and (4) what values orientation session can be proposed from the findings of the study?


 Methodology. The design is qualitative specifically a phenomenological study. It probes if quality of care changed after a DNR and most especially, on the reasons why it changed and the possible effect of it towards the professional and personal self.  Nurses from varied tertiary hospitals were taken as respondents comprised of ten forming the primary group, seven comprising the focus group to whom responses were further dug up and three narrators.  Significant others and other nurses served as validation in confirming and affirming the common themes that were identified. The primary group where made to fill up an interview guide before the formal interview started.  Each of them was given consent for an audio-video recording.  Those who refused, were taken as primary group wherein face to face interview was done while those who signed, were considered as focus group where total investigation of the responses were done.  After which,. the data were validated through a researcher-made questionnaire and informal interviews with nurses excluded in the study, as well as of significant others.  Collaizi's method of data analysis was utilized in this study. This involves formulating meanings from transcriptions and organizing them into clusters of theme.


 Findings. Most of the responses from the interview are intertwined and have common responses although there are deviating and refuting ideas.  Most viewed the patient as a person that still needs holistic physical care while before while after the DNR, as a person that needs little physical care.  Socially, as a person who has the same social needs as of the healthy individuals.  Their views didn't change after the DNR order was consented.  Mentally, the respondents view the patient before the DNR as an individual needing the same cognitive stimulation as of the usual individuals to an individual needing little mental stimulation after the DNR order.  Spiritually, before the DNR, as a person whose needs do not differ from those of the healthy individuals while as a person who needs more than the usual spiritual health after the order.


            Most of the respondents show their motivation when it comes of their utmost knowledge in taking care of a DNR patient through constant assessment of the status in order to know his moment-to-moment condition; skill-wise through doing bedside care moreover machine manipulation while some, alongside with machines and attitudinally, most of them show it through viewing the patient the same with the usual ones - due to a just and quality care and professionally through being a patient advocate, voicing out his rights. The common themes formulated out of the responses are (1) patient attachment; (2) conflicting roles; (3) hopelessness; (4) perceived incompetence; (5) conscience and idealism and (6) work exhaustion.


 Conclusion.  Nurses have different but not that extreme difference in the way they view a person in their care that is also known as the patient.  These views have a great significant in the way they render the care after the patient was placed on a Do-Not-Resuscitate Order and was consented by the family


            The longer is the experience, the more emotionally-stable is a nurse, while the shorter, the more labile.  The categorization of the respondents according to their years proved that those who have been staff nurses for t least five years, do not have guilt or feelings of incompetence compared to those who are in the service for three years at most.


            Most importantly, the prejudgment on the nurses' attitude in taking care of a DNR patient, which is being uncarative, does not apply to all.  There may be some factors where in one way or one instance, had been but it was unintentional.  There are a lot of others that might have contributed to such.  The traditional thought that technology forfeits the nurse of being competent was rejected because for them it is of very great help if used well in order to increase the care quality and not letting it replace the nurse in totality.  Therefore, technology is really of an advantage.


            And lastly, nurses have felt extreme feelings that stemmed out from the experiences in taking care of a DNR patient.  Just when we thought, it is not the relatives alone that are experiencing the emotional trauma, anticipatory grieving and the like but also, the nurses whom the public might have known to be of apathetic individuals.


 Recommendation. Based on the above findings and conclusions, I have come up with the recommendations that would address the detrimental effects of the nurses' experiences in the care of a DNR patient.  These are the following (1) that the nursing service administrators would provide at least a quarterly counseling on staff nurses who are bombarded with so many patient deaths in order to cleanse the nurse out of the trauma that she might be in due to it;  (2) focus group discussions of the health care team involving the care of the DNR patient should be done as necessary in order to provide a more focus and individualized care and above all, an emotionally-traumatized member, which is most often the nurse, brought about by the experience could verbalized his sincerest hurts or ideas; (3) the issue of work exhaustion due to understaffing should be addressed since it is one of the most common reasons.  More physically-exhausting hospital areas or those who have a great number of admitted patients should have a proportionate number of staff also; and (4) brochures or a written literature regarding the DNR order should be given to the significant others after consenting to the order so that things will be very clear and in utmost understanding within the level of the patient's relatives, including the restricted interventions as well as the mandatory medical interventions which are to be given.  Everything should be specified.  Nurses are mistaken as apathetic because some relatives misinterpreted the restrictions of the order.

References

1. Locsin, Rozzano R. Technological Competency as Caring inNursing USA: Sigma Theta Tau International, 2005.
2. Pagatpatan, C. . "Field Notes of a Research Affiliate" Philippine Journal of Nursing 79(2):
3. University of the PhilippinesAdult Health Nursing Module. Philippines: University of the Philippines Publishing, 2004.

Physical Location

LocationLocation CodeAvailable FormatAvailability
Cebu Normal University T C112 2011 Abstract Print Format

 
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