• Journal of Hospice and Palliative Care
• /
• v.18 no.3
• /
• pp.208-218
• /
• 2015

Purpose: Although a Do-Not-Resuscitate (DNR) order is widely in use, it is one of the challenging issues in end-of-life care. This study was conducted to investigate attitudes toward DNR according to education and clinical experience. Methods: Data were collected using a structured questionnaire comprising 30 items in a tertiary hospital in Seoul, Korea. Results: Participants were 238 nurses and 72 physicians. Most participants (99%) agreed to the necessity of DNR for reasons such as dignified death (52%), irreversible medical condition (23%) and patients' autonomy in decision making (19%). Among all, 33% participants had received education about DNR and 87% had DNR experience. According to participants' clinical DNR experience, their attitudes toward DNR significantly differed in terms of the necessity of DNR, timing of the DNR consent and post-DNR treatments including antibiotics. However, when participants were grouped by the level of DNR education, no significant difference was observed except in the timing of the DNR consent. Conclusion: This study suggests that the attitudes toward DNR were more affected by clinical experience of DNR rather than education. Therefore, DNR education programs should involve clinical settings.

• Journal of Hospice and Palliative Care
• /
• v.20 no.2
• /
• pp.122-130
• /
• 2017

Purpose: The purpose of this study is to describe and understand the meaning and the structure of subjective experiences of intensive care nurses with death of patients with do-not-resuscitate (DNR) orders. Methods: Data were collected from eight intensive care nurses at general hospitals using individual in-depth interviews and analyzed by phenomenological research method. Results: The nurses' experiences were grouped into four theme clusters: 1) ambiguity of death without correct answer, 2) a dilemma experienced at the border between death and work, 3) the weight of death that is difficult to carry and 4) death-triggered reflection of life. Conclusion: It is necessary to develop accurate judgment criteria for DNR, detailed regulations on the DNR decision process, guidelines and education on DNR patient care for nurses. It is also needed to develop an intervention program for DNR patients' families.

• Journal of Korean Academy of Nursing Administration
• /
• v.9 no.3
• /
• pp.447-458
• /
• 2003

Purpose: To examine the awareness and experiences of nurses and physicians on DNR. Method: The sample contained of 199 nurses and 98 physicians. The Instrument used in this study was The Nurses' Understanding and Attitude on DNR(AEDNR) developed by the Han et al and revised by the research the AEDNR included 29 items. Result: About 97.3% of them feel the necessity of DNR, Majority of subject(78.8%) have practiced DNR by the demand of 'the patient's family' and 91.8% of them made a medical record at the time they carried out DNR. There were no significant differences in their perceived necessity of DNR between nurses and physicians. Conclusion: This study can be a basis for making objective standards educational, ethical, and legal issues concerning DNR.

• Journal of the Korea Convergence Society
• /
• v.8 no.2
• /
• pp.63-72
• /
• 2017

This study was identify the awareness and ethical attitudes of DNR in nursing college students and use it as basic data to help patients with DNR. The results of the questionnaire were collected from June 1, 2016 to July 10, 2016 and analyzed using SPSS 23.0 program. As a result of the analysis, the recognition of DNR was in favor of the necessity of DNR, the decision of DNR by patient and family will, and the need for documented guidelines. Ethical attitudes favored decisions made by the patient's will, range of treatment, explanation, and guidance, and opposed decisions made by the primary care physician and reduced provision of basic care. Ethical attitudes according to general characteristics were significantly different according to grade, clinical practice experience, educational experience on ethical values, educational experience on DNR, satisfaction with life, and values for death. Based on the results of this study, more follow - up studies are needed to establish the criteria for DNR.

• Journal of Korean Academy of Nursing Administration
• /
• v.11 no.3
• /
• pp.255-264
• /
• 2005

This study is a descriptive research in investigating the perception of doctors and nurses with regard to DNR, and data were collected through survey questionnaires. The period of collecting data was between July 15 and October 30, 2004, distributing 128 questionnaires to 128 participants, and a total of 110 questionnaires from 55 doctors and 55 nurses were collected (86%)among 70 different hospitals. The collected data were analyzed using SAS program to get real number and percentage, and were also analyzed with $X^2$-test. The Study Results are as follows: 1. Respondents who agreed with the necessity of DNR was 97.27%, the reasons of DNR necessity were 59.20% of 'impossibility of recovery in spite of lots of efforts,' and 35.20% of 'for the purpose of choosing a comfortable and dignified death,' and 97.2% of respondents answered that it was necessary to give explanation of DNR to serious case patients, terminal patients and their family. 2. Problems derived from DNR decisions were 44.44% of 'lack of treatment and nursing,' 21.11% of 'guilty conscience about failing to do best efforts,' and 71.57% of CPR implementation right after DNR decision. 3. Reasons of implementing CRP for patients with DNR decision were 50.94% of 'for the presence of family and relatives at the point of patient's death,' 20.76% of 'guardian's change of DNR decision,' and 16.98% of 'no communication for the consent after DNR decision.' 4. With regard to who was to make DNR decision? there was a difference in the opinion between doctors' and nurses' group while the group of doctors chose 'by the consent of the family and the doctor in charge,' and the group of nurses chose 'patient's intension,' and with regard to Have you received DNR related education? and Will people who want DNR increase if there is explanation given? there was a difference between the two groups. 5. In the catholic institutions, respondents of 71.7% said that it was necessary to take DNR depending upon the situation, and 73% said that they had performed DNR before. 6. In the institutions with over 500 beds, 91.92% of respondents said that there should be an establishment of guideline book as a written format to implement DNR. From the results of this study, it was found that DNR was implemented and executed broadly in clinical fields in the absence of necessary instructions and/or guideline, and that DNR order was placed to the group of doctors who got less opportunity for proper education than did that of nurses.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.11 no.12
• /
• pp.4907-4921
• /
• 2010

The object of this descriptive survey research was to provide basic information source for building objective standards of DNR (Do Not Resuscitate) that can be clinically applied, by analyzing college students' awareness and attitude toward DNR. The participants of the study were 1,267 students from one college of Daegu, South Korea. The structured survey questionnaire was used for data collection, and the survey was conducted from 1-31 July, 2010. The error and percentage was estimated by SPSS 17.0 program, and analyzed with $x^2$-test. As a result of comparing the nursing students' and non-health care major students' awareness and attitude toward DNR, the significant differences were found in the necessity of DNR, reason for supporting DNR, reason for opposing DNR, and DNR decision-maker, among the awareness dimension; among the attitude dimension, significant differences were found in implication of family DNR and self-DNR. Comparing the nursing students' and non-health care major students' awareness toward DNR related information provision, researchers have found significant differences in the necessity of giving information on DNR, timing of the DNR information provision, result of the DNR-related information provision, and guidelines for the DNR information provision. In terms of the difference in DNR's necessity recognition by the demographic information, the significant differences existed based on the religion and the history of blood donation; in terms of the differences in attitude toward DNR decision-maker, the differences were found on the religion and the number of siblings. For the attitude toward family member's DNR, the significant differences existed for the sex, age, economic status, religion, the number of siblings, the history of familial illness and death, and experience of blood donation; the attitude toward the DNR for the self was significantly differed by the sex, economic status, the number of siblings, and the history of familial illness and death. To establish the standards for DNR based on the study, we suggest more well-designed future studies.

• Journal of Korean Academy of Nursing
• /
• v.38 no.2
• /
• pp.298-309
• /
• 2008

Purpose: The purpose of the study was to describe the experiences of do-not-resuscitate (DNR) among nurses. Methods: Data were collected by in-depth interviews with 8 nurses in 8 different hospitals. Conventional qualitative content analysis was used to analyze the data. Results: Eight major themes emerged from the analysis: DNR decision-making bypassing the patient, inefficiency in the decision-making process of DNR, negative connotation of DNR, predominance of verbal DNR over written DNR, doubts and confusion about DNR, least amount of intervention in the decision for DNR change of focus in the care of the patient after a DNR order, and care burden of patients with DNR. Decision-making of DNR occurred between physicians and family members, not the patients themselves. Often high medical expenses were involved in choosing DNR, thus if choosing DNR it was implied the family members and health professionals as well did not try their best to help the patient. Verbal DNR permission was more popular in clinical settings. Most nurses felt guilty and depressed about the dying/death of patients with DNR. Conclusion: Clearer guidelines on DNR, which reflect a family-oriented culture, need to be established to reduce confusion and to promote involvement in the decision-making process of DNR among nurses.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.10 no.12
• /
• pp.3931-3942
• /
• 2009

This study as a descriptive survey was to investigate recognition and attitudes on ethical issues for DNR of 119 rescue party who are working on the field, and to develop an objective framework which helps rescue team to manage DNR patients. Data were collected from the structured questionnaire, and subject were 226 rescue party in Jeollabuk-do area in Korea. Study was practiced from May 6 through June 20, 2009, and the data were analyzed by frequency, percentage, $x^2$-test, crosstabs using SPSS Win 12.0. The results indicated that ethical attitudes on subjects' factors(sex, age, religion, marital status, clinical working career, current working area, current position, educational experiences for ethics and values, DNR education places, DNR implication experience, and DNR consulting demands) were statistically significant. Therefore, following researches will be necessary in order to consider measures about DNR based on this study.

• 한국노년학
• /
• v.27 no.2
• /
• pp.323-334
• /
• 2007

This cross-sectional descriptive study was performed to investigate the relationship among attitude toward DNR orders, depression, and self-esteem in the elderly. Method: The participants of this study were 99 elderly individuals who were hospitalized in four university hospitals in Seoul and Kangwon-do from October 1, 2006 to October 21, 2006. The data were collected using self-administered questionnaires. Results: The mean scores were 3.99 for attitude toward DNR orders(range of 1-5), 6.64 for depression(range of 1-15), and 26.83 for self-esteem(range of 10-40). Self-esteem was significantly correlated with attitude toward DNR orders(r=.200, p=.047). About half of the participants(49.5%) responded that the proper time for obtaining DNR consent was when they were healthy and could express their own intentions and make the decision by themselves. Most of the participants showed a positive attitude toward DNR orders. The participants preferred to make the DNR decision when they were healthy. Therefore, health care providers working with the elderly should try to discuss the DNR decision with their patients when they are conscious and able to make the DNR decision by themselves rather than leaving the decisions up to the patient's family members

• Korean Journal of Adult Nursing
• /
• v.25 no.3
• /
• pp.322-331
• /
• 2013

Purpose: This study was conducted to understand the meaning of the DNR experiences of nurses. Methods: The data were collected through in-depth interviews, observation, and field records with five nurses from November 2009 to February 2011. The data were analyzed using narrative inquiry methodology. Results: Three fundamental themes were derived from data analysis as following: 'faithfulness to care for comfort,' 'helping for peaceful farewells between the patient and the family,' 'reflecting one's lives with a collision of feeling toward the death.' Conclusion: The results indicate that nurses take a role of an advocate in caring for DNR patients and being concerned about their families' conflict and anguish. In addition, this study indicates the importance of education on living will, advanced directives and preparation for the death tailored to the public including healthcare professionals.