'Not for resuscitation': the student nurses' viewpoint

Area of Science:

• Medical Ethics
• Qualitative Health Research
• Nursing Practice

Background:

• A significant proportion of hospital inpatients are designated 'not for resuscitation' (NFR).
• The impact of NFR decisions on nursing care and the decision-making process remain under-investigated.
• Student nurses experience distress related to NFR patients and end-of-life care.

Purpose of the Study:

• To investigate the phenomenon of 'not for resuscitation' designations in hospital patients.
• To explore the effects of NFR status on nursing care and decision-making processes.
• To identify factors contributing to student nurses' distress regarding NFR patients.

Main Methods:

• Qualitative methodology employing grounded theory.
• Interviews with 71 student nurses from two district general hospitals.
• Analysis of interview transcriptions to identify conceptual categories.

Main Results:

• NFR designations varied widely, reaching up to 100% in geriatric and psychiatric wards.
• Junior medical staff could make NFR decisions without consulting nurses, patients, or relatives.
• Nurses provided increased care for NFR patients, while medical and physiotherapy staff disengaged.
• Participants believed cardiopulmonary resuscitation conflicted with a dignified death.
• Concerns were raised about senior nurses' handling of junior staff distress during post-mortem care.

Conclusions:

• NFR decisions are often made without multidisciplinary or patient/family consultation.
• Nurses dedicate more time to NFR patients, facing withdrawal from other healthcare professionals.
• Enhanced communication and joint decision-making among healthcare professionals are crucial to reduce student nurses' distress.