A/Prof. Gemma Mcerlean1
1School of Nursing, University of Wollongong , Sydney, Australia, 2St George Hospital , Kogarah, Australia
Biography:
Dr. Gemma McErlean is a conjoint Associate Professor at UOW and St George Hospital. She is a registered nurse with over 20 years of experience. Her research focuses on cancer survivorship, ethical nursing practice, and building research capacity to enhance nurse-led clinical research and evidence translation in nursing practice.
Abstract:
When Do Not Resuscitate (DNR) orders have not been documented, inpatient nurses must decide whether to initiate CPR. This study explored tertiary-based nurses' decision-making, perspectives and experiences about initiating CPR on patients who have unequivocal signs of death but no DNR order.
This was a multisite cross-sectional survey. Participants responded to two clinical scenarios (Mr D 74yo male with cancer, and Mr G 35yo well male post-MVA) which asked what they would do if they found the patient pulseless, cold, blue and stiff, but without a DNR order – initiate a CODE BLUE, perform limited CPR (a slow or show code) or confirm death.
Five hundred and thirty one nurses completed the survey. For Mr D, 61% (n=324) of respondents would call a CODE BLUE, 23.9% (n=127) would perform limited CPR and only 14.3% (n=76) would confirm death. In contrast, for Mr G, 92.6% (n=492) would call a CODE BLUE, 4.3% (n=23) would perform limited CPR, and 1.7% (n=9) would confirm death. The major reasons why nurses initiate a CODE BLUE were ‘In the absence of an DNR order, there is no option but to begin CPR’ (Mr D 90%, Mr G 61.5%, p=0.5389), ‘I am required by hospital policy to do so’(Mr D 65.4%, Mr G 60.9%, p=0.000), ‘I am required by law to do so’ (Mr D 52.8%, Mr G 47.1%, p=0.000),‘It is what I was trained to do’ (Mr D 31.3%, Mr G 44.3% p=0.000), and ‘Doing so enables me to fulfil my duty of care to the patient’ (Mr D 31.1%, Mr G 57.5% p=0.000).
This study reports the majority of nurses would commence CPR in patients with clear signs of death in the absence of a DNR order. This appears to be related to defensive practice, managerialism, age bias, and unrealistic expectations of CPR.