Ethical considerations of DNR orders from nursing perspective/DNR-päätöksen eettiset näkökohdat hoitotyön näkökulmasta

Do not resuscitate (DNR) is an order from the responsible physician. This order stipulates that in the event of a cardiac arrest neither basic nor advanced cardiopulmonary resuscitation (CPR) be performed. The aim of the thesis was to conduct a descriptive literature review to develop professional understanding for nurses of DNR order. The purpose was to increase nurses´ knowledge about this matter to strengthen their nursing skills in dealing with these ethical issues. A thorough understanding of DNR orders could assist nurses to achieve professional growth particularly in terms of patient care and ethical competence. With the method of literature review, data was collected from CINAHL, PubMed and Joanna Briggs Institute EBP. Articles were selected from predetermined inclusion and exclusion criteria. The selections were analyzed with the method of thematic content analysis. The main themes identified after content analysis include, 1) Nurses’ attitudes and understanding about DNR and influential factors on nurses’ attitudes, 2) Nurses’ opinions toward policy, guidelines, documentation and legalization for DNR orders, 3) Nurses’ views about patient role in DNR orders, 4) Nurses’ views on their own role in DNR orders, 5) Nurses’ views on family role in DNR orders. The results revealed that nurses’ understanding of DNR varied and there were also existing negative attitudes of nurses in relation to DNR orders. However, nurses reflect their ethical competence in ethical matter by the respect for patient autonomy and family role in DNR decision making process and nurses’ willingness to learn more about DNR and also their need for more education, guidelines, clear documentation and legalization of DNR as support