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Title: Do not attempt resuscitation : the importance of consensual decisions
Authors : Imhof, Lorenz
Mahrer Imhof, Romy
Janisch, C.
Kesselring, A.
Zürcher-Zenklusen, R.
Published in : Swiss medical weekly
Volume(Issue) : 141
Issue : w13157
Publisher / Ed. Institution : EMH Schweizerischer Ärzteverlag
Issue Date: 3-Feb-2011
License (according to publishing contract) : CC BY-NC-ND 4.0: Attribution - Non commercial - No derivatives 4.0 International
Type of review: Peer review (Publication)
Language : English
Subject (DDC) : 610: Medicine and health
Abstract: Aims: to describe the involvement and input of physicians and nurses in cardiopulmonary resuscitation (cpr / do not attempt resuscitation (dnar) decisions; to analyse decision patterns; and understand the practical implications. Design: a qualitative grounded theory study using one-time open-ended interviews with 40 volunteer physicians and 52 nurses drawn from acute care wards with mixes of heterogeneous cases in seven different hospitals in german-speaking switzerland. Results: establishing dnar orders in the best interests of patients was described as a challenging task requiring the leadership of senior physicians and nurses. Implicit decisions in favour of cpr predominated at the beginning of hospitalisation; depending on the context, they were relieved/superseded by explicit dnar decisions. Explicit decisions were the result of hierarchical medical expertise, of multilateral interdisciplinary expertise, of patient autonomy and/or of negotiated patient autonomy. Each type of decision, implicit or explicit, potentially represented a team consensus. Non-consensual decisions were prone to precipitate personal or team conflicts, and, occasionally, led to non-compliance. Conclusion: establishing dnar orders is a demanding task. Reaching a consensus is of crucial importance in guaranteeing teamwork and good patient care. Communication and negotiation skills, professional and personal life experience and empathy for patients and colleagues are pivotal. Therefore, leadership by experienced senior physicians and nurses is needed and great efforts should be made with regard to multidisciplinary education.
Departement: Health Professions
Organisational Unit: Institute of Nursing (IPF)
Publication type: Article in scientific Journal
DOI : 10.21256/zhaw-2743
ISSN: 1424-7860
Appears in Collections:Publikationen Gesundheit

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