'Should We Start CPR?': How Iranian Nurses Make Resuscitation Decisions in Intensive Care Units?

Area of Science:

• Critical Care Medicine
• Nursing Ethics
• Qualitative Research

Background:

• Initiation of resuscitation (IOR) in intensive care units (ICUs) presents significant ethical challenges for nurses.
• Nurses often act as first responders during cardiac arrest, facing complex decisions beyond standardized algorithms.

Purpose of the Study:

• To explore and explain the process of initiation of resuscitation (IOR) decision-making among Iranian ICU nurses.

Main Methods:

• Qualitative study employing grounded theory methodology (Strauss and Corbin).
• Data collected through semi-structured interviews with 14 ICU nurses, managers, and physicians in Iran.
• Analysis utilized constant comparative methods with iterative coding and memo writing.

Main Results:

• Nurses experience a 'limbo between duty and outcome,' balancing resuscitation mandates with prognosis and quality of life concerns.
• Patient-centered self-protection emerged as a core category, influencing decisions amidst legal ambiguity, cultural values, and hierarchical structures.
• Strategies ranged from rule-driven to defensive, leading to outcomes like moral distress or professional fulfillment.

Conclusions:

• IOR decision-making in ICUs is dynamic, context-dependent, and morally complex, requiring negotiation under uncertainty.
• Recommendations include context-sensitive guidelines, legal clarity, ethical support, leadership, and simulation-based education to enhance nurses' moral agency and patient-centered care.