Investigating doctors and nurses views about the decision of Do-Not-Resuscitate (DNR) in patients of ICU. A systematic review

In the Intensive Care Unit (ICU) hospitalized patients with major decisions taken with regard to their treatment. The cardiopulmonary resuscitation (CPR) process is critical for patients with potentially reversible diseases. In Medicine "do not resuscitate" (DNR) is a legal order which concerns patient's desire not to accept CPR if the heart cease to operate or stop breathing. Aim: The aim of this review was to investigate doctors' and nurses' views on DNR decision making concerning ICU patients. Material-Method: The methodology used was the review of Greek and foreign literature in databases (Iatrotek, Pubmed, Cinahl, Scopus,). The keywords used were "do not resuscitate decision," "intensive care unit", "ethical issues", "doctor" "nurse", "end-stage patient." Results: 15 published articles were found. Nurses having greater self-confidence discuss more easily DNR decisions with patients and their relatives. Moreover they would like to participate more often in such decision. With regard to doctors, it seems that their experience in ICU affect their decision making. Most of the doctors are not aware of the legal side of DNR decision. Moreover, they appear more willing to discuss such decision for patients with poor prognosis. Conclusions: The decision-making such as DNR is a point of reflection on the legal framework and ethical rules governing the implementation of CPR. Different views of doctors and nurses in deciding DNR cause a lot of worry and it is necessary to carry out further studies to draw firm conclusions.

Keywords: Do-not-resuscitate order, intensive care unit, ethical issues, nurse, doctor, end-stage patient