A mixed-methods study of DNACPR in nursing practice

Abstract

Background: Decisions relating to CPR have been described as ethically complex. Previous literature has highlighted the potential benefits but also harms associated with ‘do not attempt cardiopulmonary resuscitation’ (DNACPR), although typically focusing on medical practitioners. Objective: This study explored understandings of DNACPR among nurses caring for older people. Methods: A reflexive thematic analysis of regulatory hearing transcripts (n=30) informed the construction of an online questionnaire completed by 2.8% (n = 352) of the Royal College of Nursing (UK) Older People’s Nursing Forum. Results: Nurses were found to be willing to knowingly administer futile CPR (37.5%, n = 132), but also willing to withhold CPR in the absence of a valid DNACPR form. Life support training was the most significant predictor of responses being in line with UK guidance on decisions related to CPR (p <0.001). Nurses with Advanced Life Support (ALS) were eleven times more likely to understand that DNACPR relates to CPR only (p <0.001). Nurses from the Nursing Home Sector were found to be disproportionately subject to DNACPR related regulatory action. Conclusion: ALS training may be the best intervention to prevent harm associated with futile CPR or overinterpretation of DNACPR.