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Do not attempt resuscitation orders in pediatrics

Wynne Morrison1, Ivor Berkowitz

  • 1Department of Anesthesiology and Critical Care, The children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. morrisonw@email.chop.edu

Pediatric Clinics of North America
|October 16, 2007
PubMed

Insights

Do-not-attempt resuscitation (DNAR) orders are increasing in pediatric care, coinciding with the growth of child hospice and palliative care programs. This highlights the critical need for strong communication skills when making end-of-life decisions for children.

Area of Science:

  • Pediatric critical care
  • Bioethics
  • Palliative medicine

Background:

  • Increasing prevalence of Do-not-attempt resuscitation (DNAR) orders in pediatric settings.
  • Development and expansion of pediatric hospice and palliative care programs.
  • Growing need for ethical decision-making frameworks in pediatric end-of-life care.

Observation:

  • DNAR orders necessitate careful consideration of technology use in pediatric care.
  • The decision-making process for DNAR orders requires specific interpersonal skills.
  • Effective communication is paramount in navigating complex pediatric end-of-life scenarios.

Findings:

  • Relationship building, active listening, and empathic concern are essential components of pediatric DNAR discussions.
  • These skills facilitate shared decision-making between healthcare providers and families.
  • Successful implementation of DNAR orders relies on a foundation of trust and understanding.

Implications:

  • Enhanced communication strategies can improve the quality of care for children nearing end-of-life.
  • Training healthcare professionals in empathic communication is crucial for pediatric palliative care.
  • Ethical guidelines for DNAR orders should emphasize the importance of patient-centered communication and family involvement.

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