Do-not-resuscitate decisions in the medical ICU : Comparing physician and nurse opinions
To determine how soon after admission to a medical ICU physicians and nurses decide that attempts at resuscitation are inappropriate and how frequently physicians and nurses disagree about do-not-resuscitate (DNR) decisions. Prospective, opinion survey of care providers. Ten-bed adult medical ICU in...
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| Veröffentlicht in: | Chest 1997-04, Vol.111 (4), p.1106-1111 |
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| creator | ELIASSON, A. H HOWARD, R. S TORRINGTON, K. G DILLARD, T. A PHILLIPS, Y. Y |
| description | To determine how soon after admission to a medical ICU physicians and nurses decide that attempts at resuscitation are inappropriate and how frequently physicians and nurses disagree about do-not-resuscitate (DNR) decisions.
Prospective, opinion survey of care providers.
Ten-bed adult medical ICU in a university-affiliated tertiary care referral hospital.
Consecutive adult medical ICU admissions.
Over 10 months, physicians and nurses were surveyed independently every day regarding their opinions about DNR issues on each patient in the ICU.
ICU day when DNR order was deemed appropriate by either physicians or nurses.
Of 368 consecutive admissions, 84 (23%) patients were designated DNR during their ICU stay. In 6 of these 84 cases (7%), the responsible nurse did not agree that DNR orders were appropriate. In the remaining 78 patients designated DNR, the median time for physicians to recommend DNR (median, 1 day; range, 0 to 22 days) was not significantly different from the median time for nurses (median, 1 day; range, 0 to 13 days); (p=0.45). For the 284 patients not designated DNR, physicians and nurses both believed DNR was appropriate in 14 cases (5%), but a DNR order was not written five times (2%) because there was not time to do so and nine times (3%) because patient or family did not concur. Physicians and nurses disagreed about a DNR recommendation in 33 of the 284 patients not designated DNR (12%). Physicians were more likely to believe that DNR was appropriate than were nurses (p |
| doi_str_mv | 10.1378/chest.111.4.1106 |
| format | Article |
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Prospective, opinion survey of care providers.
Ten-bed adult medical ICU in a university-affiliated tertiary care referral hospital.
Consecutive adult medical ICU admissions.
Over 10 months, physicians and nurses were surveyed independently every day regarding their opinions about DNR issues on each patient in the ICU.
ICU day when DNR order was deemed appropriate by either physicians or nurses.
Of 368 consecutive admissions, 84 (23%) patients were designated DNR during their ICU stay. In 6 of these 84 cases (7%), the responsible nurse did not agree that DNR orders were appropriate. In the remaining 78 patients designated DNR, the median time for physicians to recommend DNR (median, 1 day; range, 0 to 22 days) was not significantly different from the median time for nurses (median, 1 day; range, 0 to 13 days); (p=0.45). For the 284 patients not designated DNR, physicians and nurses both believed DNR was appropriate in 14 cases (5%), but a DNR order was not written five times (2%) because there was not time to do so and nine times (3%) because patient or family did not concur. Physicians and nurses disagreed about a DNR recommendation in 33 of the 284 patients not designated DNR (12%). Physicians were more likely to believe that DNR was appropriate than were nurses (p<0.0005), with physicians alone recommending DNR 29 times (10%) and nurses alone favoring DNR in four cases (1%).
At our institution, recognition of DNR appropriateness by nurses and physicians occurs over a similar time frame. However, physicians are more likely to recommend DNR in cases of disagreement between nurses and physicians.</description><identifier>ISSN: 0012-3692</identifier><identifier>EISSN: 1931-3543</identifier><identifier>DOI: 10.1378/chest.111.4.1106</identifier><identifier>PMID: 9106594</identifier><identifier>CODEN: CHETBF</identifier><language>eng</language><publisher>Northbrook, IL: American College of Chest Physicians</publisher><subject>Aged ; Attitude of Health Personnel ; Biological and medical sciences ; Confidence intervals ; Critical care ; Data Collection ; Ethics ; Female ; Glasgow Coma Scale ; Humans ; Intensive Care Units ; Male ; Medical sciences ; Middle Aged ; Nurses ; Nurses - psychology ; Nursing care ; Patients ; Physicians ; Physicians - psychology ; Physiology ; Prospective Studies ; Public opinion surveys ; Resuscitation Orders ; Time Factors</subject><ispartof>Chest, 1997-04, Vol.111 (4), p.1106-1111</ispartof><rights>1997 INIST-CNRS</rights><rights>Copyright American College of Chest Physicians Apr 1997</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2637835$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9106594$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>ELIASSON, A. H</creatorcontrib><creatorcontrib>HOWARD, R. S</creatorcontrib><creatorcontrib>TORRINGTON, K. G</creatorcontrib><creatorcontrib>DILLARD, T. A</creatorcontrib><creatorcontrib>PHILLIPS, Y. Y</creatorcontrib><title>Do-not-resuscitate decisions in the medical ICU : Comparing physician and nurse opinions</title><title>Chest</title><addtitle>Chest</addtitle><description>To determine how soon after admission to a medical ICU physicians and nurses decide that attempts at resuscitation are inappropriate and how frequently physicians and nurses disagree about do-not-resuscitate (DNR) decisions.
Prospective, opinion survey of care providers.
Ten-bed adult medical ICU in a university-affiliated tertiary care referral hospital.
Consecutive adult medical ICU admissions.
Over 10 months, physicians and nurses were surveyed independently every day regarding their opinions about DNR issues on each patient in the ICU.
ICU day when DNR order was deemed appropriate by either physicians or nurses.
Of 368 consecutive admissions, 84 (23%) patients were designated DNR during their ICU stay. In 6 of these 84 cases (7%), the responsible nurse did not agree that DNR orders were appropriate. In the remaining 78 patients designated DNR, the median time for physicians to recommend DNR (median, 1 day; range, 0 to 22 days) was not significantly different from the median time for nurses (median, 1 day; range, 0 to 13 days); (p=0.45). For the 284 patients not designated DNR, physicians and nurses both believed DNR was appropriate in 14 cases (5%), but a DNR order was not written five times (2%) because there was not time to do so and nine times (3%) because patient or family did not concur. Physicians and nurses disagreed about a DNR recommendation in 33 of the 284 patients not designated DNR (12%). Physicians were more likely to believe that DNR was appropriate than were nurses (p<0.0005), with physicians alone recommending DNR 29 times (10%) and nurses alone favoring DNR in four cases (1%).
At our institution, recognition of DNR appropriateness by nurses and physicians occurs over a similar time frame. However, physicians are more likely to recommend DNR in cases of disagreement between nurses and physicians.</description><subject>Aged</subject><subject>Attitude of Health Personnel</subject><subject>Biological and medical sciences</subject><subject>Confidence intervals</subject><subject>Critical care</subject><subject>Data Collection</subject><subject>Ethics</subject><subject>Female</subject><subject>Glasgow Coma Scale</subject><subject>Humans</subject><subject>Intensive Care Units</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nurses</subject><subject>Nurses - psychology</subject><subject>Nursing care</subject><subject>Patients</subject><subject>Physicians</subject><subject>Physicians - psychology</subject><subject>Physiology</subject><subject>Prospective Studies</subject><subject>Public opinion surveys</subject><subject>Resuscitation Orders</subject><subject>Time Factors</subject><issn>0012-3692</issn><issn>1931-3543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpdkU1PwzAMhiMEGmNw54IUIcStI99tuKHyNWkSFyZxq9I0ZZm6pCTtYf-eICoOXGzZfmzZrwG4xGiJaV7c6a2JwxJjvGTJInEE5lhSnFHO6DGYI4RJRoUkp-Asxh1KMZZiBmYysVyyOfh49JnzQxZMHKO2gxoMbIy20XoXoXVw2Bq4N43VqoOrcgPvYen3vQrWfcJ-e4hWW-Wgcg10Y4gG-t66n95zcNKqLpqLyS_A5vnpvXzN1m8vq_JhnfVEkCErJC1MrakyDaetlLnmhOa1aQhnXLYt11LXKmcpi2vFmlrkhphcFbWRAglNF-D2d24f_NeY1Kj2NmrTdcoZP8YqLySTnOAEXv8Dd34MLu1WEYRYTknBE3Q1QWOdrq76YPcqHKpJr1S_meoqJkXaoFzS6g8jIj2FcvoNrHZ56g</recordid><startdate>19970401</startdate><enddate>19970401</enddate><creator>ELIASSON, A. 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Y</creator><general>American College of Chest Physicians</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>19970401</creationdate><title>Do-not-resuscitate decisions in the medical ICU : Comparing physician and nurse opinions</title><author>ELIASSON, A. H ; HOWARD, R. S ; TORRINGTON, K. G ; DILLARD, T. A ; PHILLIPS, Y. Y</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p262t-8938ebc3aed53f997c5237bed25459ff5c9cba745231ba4db67e2e7a8be9606c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>Aged</topic><topic>Attitude of Health Personnel</topic><topic>Biological and medical sciences</topic><topic>Confidence intervals</topic><topic>Critical care</topic><topic>Data Collection</topic><topic>Ethics</topic><topic>Female</topic><topic>Glasgow Coma Scale</topic><topic>Humans</topic><topic>Intensive Care Units</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nurses</topic><topic>Nurses - psychology</topic><topic>Nursing care</topic><topic>Patients</topic><topic>Physicians</topic><topic>Physicians - psychology</topic><topic>Physiology</topic><topic>Prospective Studies</topic><topic>Public opinion surveys</topic><topic>Resuscitation Orders</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>ELIASSON, A. H</creatorcontrib><creatorcontrib>HOWARD, R. S</creatorcontrib><creatorcontrib>TORRINGTON, K. G</creatorcontrib><creatorcontrib>DILLARD, T. A</creatorcontrib><creatorcontrib>PHILLIPS, Y. 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H</au><au>HOWARD, R. S</au><au>TORRINGTON, K. G</au><au>DILLARD, T. A</au><au>PHILLIPS, Y. Y</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Do-not-resuscitate decisions in the medical ICU : Comparing physician and nurse opinions</atitle><jtitle>Chest</jtitle><addtitle>Chest</addtitle><date>1997-04-01</date><risdate>1997</risdate><volume>111</volume><issue>4</issue><spage>1106</spage><epage>1111</epage><pages>1106-1111</pages><issn>0012-3692</issn><eissn>1931-3543</eissn><coden>CHETBF</coden><abstract>To determine how soon after admission to a medical ICU physicians and nurses decide that attempts at resuscitation are inappropriate and how frequently physicians and nurses disagree about do-not-resuscitate (DNR) decisions.
Prospective, opinion survey of care providers.
Ten-bed adult medical ICU in a university-affiliated tertiary care referral hospital.
Consecutive adult medical ICU admissions.
Over 10 months, physicians and nurses were surveyed independently every day regarding their opinions about DNR issues on each patient in the ICU.
ICU day when DNR order was deemed appropriate by either physicians or nurses.
Of 368 consecutive admissions, 84 (23%) patients were designated DNR during their ICU stay. In 6 of these 84 cases (7%), the responsible nurse did not agree that DNR orders were appropriate. In the remaining 78 patients designated DNR, the median time for physicians to recommend DNR (median, 1 day; range, 0 to 22 days) was not significantly different from the median time for nurses (median, 1 day; range, 0 to 13 days); (p=0.45). For the 284 patients not designated DNR, physicians and nurses both believed DNR was appropriate in 14 cases (5%), but a DNR order was not written five times (2%) because there was not time to do so and nine times (3%) because patient or family did not concur. Physicians and nurses disagreed about a DNR recommendation in 33 of the 284 patients not designated DNR (12%). Physicians were more likely to believe that DNR was appropriate than were nurses (p<0.0005), with physicians alone recommending DNR 29 times (10%) and nurses alone favoring DNR in four cases (1%).
At our institution, recognition of DNR appropriateness by nurses and physicians occurs over a similar time frame. However, physicians are more likely to recommend DNR in cases of disagreement between nurses and physicians.</abstract><cop>Northbrook, IL</cop><pub>American College of Chest Physicians</pub><pmid>9106594</pmid><doi>10.1378/chest.111.4.1106</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0012-3692 |
| ispartof | Chest, 1997-04, Vol.111 (4), p.1106-1111 |
| issn | 0012-3692 1931-3543 |
| language | eng |
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| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Aged Attitude of Health Personnel Biological and medical sciences Confidence intervals Critical care Data Collection Ethics Female Glasgow Coma Scale Humans Intensive Care Units Male Medical sciences Middle Aged Nurses Nurses - psychology Nursing care Patients Physicians Physicians - psychology Physiology Prospective Studies Public opinion surveys Resuscitation Orders Time Factors |
| title | Do-not-resuscitate decisions in the medical ICU : Comparing physician and nurse opinions |
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