Research of the Health Care Provider's Cognition Regarding DNAR (Do-not-Attempt-Resuscitate) in the Emergency Department

ABSTRACT

PURPOSE: Arguments are continuously raised with regard to life support therapy performed on dying patients who cannot be recovered through treatment. Therefore, this study surveyed doctors and nurses working in emergency departments in order to investigate their awareness on DNAR (Do-Not-Attempt-Resuscitate) and the changes in patient management provided after DNAR. METHODS: We conducted a survey of health care provider's cognition regarding DNAR in six emergency departments. RESULTS: A total of 54 doctors and 148 nurses participated in the survey; 75.7% of participants indicated that patient management was changed after DNAR. No difference in answers with regard to what should be maintained after DNAR was observed between doctors and nurses. However, in answers for what is maintained in practice, differences were observed for the following items 'vital sign check' (87% vs. 97.3%, p=0.004), 'input/output control' (75.9% vs. 91.2%, p=0.004), 'vasopressor' (33.3% vs. 57.4%, p=0.002), and 'antibiotics or blood products' (53.7% vs. 74.3%, p=0.005). CONCLUSION: Both doctors and nurses thought that patient management was changed after DNAR. However, differences in some opinions were observed between the two groups. In order to overcome such differences, it is important for health care providers to carry out more discussions in relation to DNAR and to develop appropriate guidelines for Korean society.