Does resuscitation status affect decision making in a deteriorating patient? Results from a randomised vignette study

Area of Science:

• Medical Ethics
• Nursing Practice
• Clinical Decision-Making

Background:

• Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders are critical in end-of-life care.
• Nurses' decision-making processes for deteriorating patients require careful examination.
• The Universal Form of Treatment Options (UFTO) offers a structured approach to contextualize resuscitation decisions within overall care plans.

Purpose of the Study:

• To investigate the impact of DNACPR orders and the UFTO on nurses' decisions regarding deteriorating patients.
• To compare the influence of DNACPR, UFTO, and a no-form control on nursing interventions.

Main Methods:

• An online survey was administered to 231 nurses across 10 NHS Trusts.
• Nurses were randomized into three groups: DNACPR, UFTO, or no-form, each presented with a case scenario.
• Decisions were categorized into Increasing Monitoring, Escalating Concern, Initiating Treatments, and Comfort Measures.

Main Results:

• Nurses in the DNACPR group initiated fewer intense interventions (monitoring, escalating, treatments) compared to UFTO and no-form groups (P < 0.001).
• No significant differences were found between the UFTO and no-form groups in overall decisions or specific intervention categories.
• Comfort measures did not differ significantly across the three groups (P = 0.201).

Conclusions:

• DNACPR orders demonstrably influence nurses' decisions regarding interventions for deteriorating patients.
• The UFTO did not show a significant difference compared to the no-form group in this study.
• The UFTO shows potential for improving how nurses manage care for critically ill patients with DNACPR status, advocating for its broader adoption.