• Journal of Hospice and Palliative Care
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• v.18 no.3
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• pp.208-218
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• 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 Korean Academy of Nursing
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• v.38 no.2
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• pp.298-309
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• 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 Korean Academy of Nursing Administration
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• v.7 no.3
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• pp.403-414
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• 2001

The study was intended to identify the nurses' experiences, understanding, and attitudes on DNR. Also, the study was to provide the data base for a standard of DNR decision-making and practice. The sample consisted of 347 nurses in eight general hospitals. The data were collected between August 1 and August 31, 2000. The data were analyzed using descriptive statistics and $x^2-test$. The results of the study were as follows : 1. Regarding DNR-related experience, 74.6 percent of the participants experienced DNR situations. Eleven percent of the participants received DNR education. DNR was most frequently (81.5%) requested by family members and relatives of patients. The decision-making on DNR was most frequently (76.8%) made by agreement between family members and medical staff. The DNR order was recorded at 81.9 percent on charts. Problems after DNR order were negligence in treatment and nursing care (30.6%) and guilty feelings due to doing the best (22.1%). CPR (cardiopulmonary resuscitation) was performed about 49.8 percent of DNR cases. 2. Regarding understanding and attitude on DNR, most of the participants (93.1%) thought DNR was necessary. The major reasons for the necessity of DNR were impossible recovery (44.4%) and death with dignity (41.1%). The decision-making on DNR was most frequently made by patient and family members (47.8%) and followed by agreement between family members and medical staff (25.6%), and patients themselves (16.4%). Most of the participants thought that medical staff must explain DNR to critical and end-of-life patients and their family members. Forty four percent of the participants thought that the most appropriate time for DNR explanation was when patients with critical disease were admitted to hospitals. Most of the participants (90.2%) thought a guide book for DNR is necessary to be made in hospitals. 3. There were significant differences in the participants' understanding and attitudes on DNR according to religion career education and experience of DNR. Of the participants those who have religions and education experience on DNR thought that there would be more DNR requests after DNR is explained to patients and family members (p<.05). In addition, there was higher understanding on the necessity of DNR in those who have more career and DNR experience(p<.01). The findings of the study suggest that a guide book for DNR need to be made with inclusion of legal, ethical, and cultural aspects. Also, there needs to be more education on DNR in medical ethics to health care professional and to provide more information on DNR to the general public.

• Journal of Digital Convergence
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• v.13 no.11
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• pp.187-196
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• 2015

The purpose of this study was to examine the understanding of contents and the convenience of use of the DNR animation mobile electronic informed consent. The subjects in this study were inpatients of long-term care hospital. As for data analysis, a statistical package SPSS 21.0K was employed. The findings of the study were as follows: First, DNR choice was 33.0%, CPR choice was 54.0% in case of the outbreak of cardiac arrest. Their principal diagnosis made statistically significant differences to their choice of DNR and CPR. Second, they got 2.50 in the understanding of the content of the DNR electronic informed consent, and got 2.37 in the convenience of use. Given the findings of the study, the DNR animation electronic informed consent is expected to help patients to have a better understanding of contents, to make their decision to choose DNR or CPR, and to sign the DNR informed consent forms themselves.

• Journal of Korean Academy of Nursing
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• v.36 no.6
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• pp.1055-1064
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• 2006

Purpose: The purpose of this study was to analyze and clarify the ambiguous concept of DNR, and to distinguish between DNR and euthanasia. Method: This study used the process of Walker & Avant's concept analysis. Result: The definable attributes of DNR were care for comfort, no further treatment and no CPR. The antecedents of DNR were the autonomy of patients and families feelings about death, the uselessness of treatment and the right to die with dignity. The process of the DNR decision should be documented and the antecedents of DNR also can be a basis for objective standards of DNR decision-making. The result of DNR was the acceptance of death by patients and families. Conclusion: DNR is decided and documented by the antecedents of DNR, and the result is a natural acceptance of death, the last process of human life. Hospice care should be activated and nurses must be patient's advocates and families' supporters in the process.

• Journal of Korean Academy of Nursing Administration
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• v.9 no.3
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• pp.447-458
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• 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
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• v.8 no.2
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• pp.63-72
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• 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 Hospice and Palliative Care
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• v.7 no.2
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• pp.232-237
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• 2004

Purpose: DNR order is generally accepted for cancer patients near the end of life at Hospice Ward. It means not only no CPR when cardiopulmonary arrest develops but no aggressive meaningless medical interventions. Usually on admission, we discuss with the patients' family about DNR order at the Hospice Ward. Recently, we experienced a terminal lung cancer patient who had been on the ventilator for two months after pulmonary arrest. CPR and artificial ventilation were performed because patient's family refused DNR order. There is no consensus when, who, and how DNR order could be written for terminal cancer patients in Korea, yet. Methods: Hospice charts of 60 patients who admitted between Jan and Jun 2003 to Hospice Ward were reviewed retrospectively. Results: The median age was 66(range $31{\sim}93$) and there were 31 males and 29 females. Their underlying cancers were lung (12), stomach (12), biliary tract (7), colon (6), pancreas (4) and others (19). The persons who signed DNR order were son (22), spouse(19), daughter (16) and others (3). But, there was no patients who signed DNR order by oneself. Thirty families of 60 patients signed on day of admission and 30 signed during hospitalization when there were symptom aggravation (19), vital sign change (4), organ failure (3) and others (4). There were 13 patients who died within 5 days after DNR order. Most of patients died at our hospice ward, except in 1 patient. The level of care was mostly 1, except in 2 patients. (We set level of care as 3 categories. Level 1 is general medical care: 2 is general nursing care: 3 is terminal care.) Conclusion: We have to consider carefully discussing DNR order with terminal cancer patients in the future & values on withholding futile intervention.

• Journal of the Korean Institute of Oriental Medical Informatics
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• v.21 no.2
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• pp.25-33
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• 2015

Purpose: The purpose of this study was to examine hospital nurses' nursing activities changes after DNR(do-not-resuscitate) decision. Methods: The subjects were 120 registered nurses working in two university hospitals. The data were collected from September 1 to September 15, 2015 using self-report questionnaires. The data were analyzed using SPSS 20.0 program. Results: DNR awareness of the educational needs was very high(91.7%). But DNR educational experience was low(59.2%). Nursing activity change was classified as the physical, emotional, spiritual, and social areas. There were significant difference among religion(F=3.459, p=.010), working unit(F=3.410, p=.036), DNR awareness of the educational needs(t=5.048, p=.027), DNR educational experience(t=-2.816, p=.006) and nursing activities changes. Conclusion: Nurses are needed DNR educational programs to take care of DNR patients. And the criteria for nursing activities related to DNR is required.

• The Korean Journal of Emergency Medical Services
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• v.19 no.2
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• pp.71-82
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• 2015

Purpose: This study aimed to investigate paramedic students' awareness and attitude toward a do not resuscitate (DNR) order and death. Methods: This research was conducted among 421 students from the Department of Emergency Medical Technology in a 4-year college located in the Chungcheong and Daejeon districts, from May 14 to 22, 2014. Data were analyzed by using IBM SPSS 21.0. Results: The mean level of attitude toward death was 2.17. The paramedic students with clinical experience showed a positive attitude toward death, of whom 72.0% answered that a DNR order is necessary. The mean level of attitude toward DNR was 2.88. The paramedic students with clinical experience showed a positive attitude toward a DNR order. They indicated that sanctity of life should be respected rather than extending ineffective treatment and that patients' decisions on DNR should be respected. The students who had more knowledge about DNR and felt the necessity of DNR had a positive attitude about death and DNR. Conclusion: Paramedic students need systematic education for proper recognition and values establishment about death and DNR.