Nurses' perceptions of attempting cardiopulmonary resuscitation on oldest old patients

This paper is a report of a study to explore nurses' thoughts and attitudes about cardiopulmonary resuscitation of oldest old patients.

Although it is recognized that nurses and doctors have different approaches to resuscitation, little is known about nurses' attitudes towards attempting resuscitation of the oldest old (85+ years).

Ten nurses working in three hospitals participated in in-depth interviews during 2009-2010. The data were analysed according to a constructivist-grounded theory tradition.

The appropriate availability of 'do not attempt resuscitation' orders was important to the participants. Participants experienced stress in end-of-life care situations when resuscitation status was not decided for patients they considered should have a 'do not attempt resuscitation' order. Participants acknowledged the difficulties in end-of-life decision-making, but stated that 'do not attempt resuscitation' orders are underused and sometimes delayed. Participants were sceptical about attempting resuscitation. Nevertheless, respect for patient autonomy was strong, and participants were adamant about the necessity of following the legal requirements governing resuscitation. Five of the participants had been asked by physicians to use 'slow codes', cardiopulmonary resuscitation efforts that intentionally are conducted too slowly for resuscitation to occur, and agreed this was unethical. Some participants described the information on cardiopulmonary resuscitation and 'do not attempt resuscitation' given by physicians to patients as inadequate.

End-of-life decisions impact on nurses' comfort in their working situation as they face ethical dilemmas and anxiety about performing cardiopulmonary resuscitation. Greater collaboration between all stakeholders might reduce these. Nurses may need additional education or updates about laws about end-of-life treatment, as participants were unaware of current legislation concerning end-of-life decision-making.