The do not resuscitate order (DNR) from the perspective of oncology nurses: A study in Saudi Arabia

Perceptions and experiences of community-based healthcare professionals in the state of Qatar having do not attempt resuscitation discussions during the COVID-19 pandemic

Introduction

The values and attitudes of healthcare professionals influence their handling of "do-not-attempt-resuscitation" (DNAR) orders, as does that of the families they interact with. The aim of this study was to describe attitudes, perceptions, and practices among community-based medical practitioners towards discussing cardiopulmonary resuscitation and DNAR orders with patients and their relatives, and to investigate if the COVID-19 pandemic affected their practice in having these discussions.

Methods

This is a researcher-developed online survey-based study which aimed to recruit a convenience sample of respondents from a total population of 106 healthcare professionals working for the Mobile Healthcare Service (MHS), Hamad Medical Corporation Ambulance Service in the State of Qatar.

Results

33 family physicians, 38 nurses, and 20 paramedics (n = 91) responded to the questionnaire, of who around 40, 8, and 50%, respectively, had engaged in Do Not Attempt Resuscitation discussions during their work with MHS. 15% of physicians who had experience with Do Not Attempt Resuscitation discussions in Qatar felt that the family or patient were not open to having such discussions. 90% of paramedics thought that Do Not Attempt Resuscitation was a taboo topic for their patients in Qatar, and this view was shared by 75% of physicians and 50% of nurses. Per the responses, the COVID-19 pandemic had not affected the likelihood of most of the physicians or nurses (and 50% of the paramedics) identifying patients with whom having a Do Not Attempt Resuscitation discussion would be clinically appropriate.

Discussion

Overall, for all three groups, the COVID-19 pandemic did not affect the likelihood of identifying patients with whom a Do Not Attempt Resuscitation discussion would be clinically appropriate. We found that the greatest barriers in having Do Not Attempt Resuscitation discussions were perceived to be the religious or cultural beliefs of the patient and/or their family, along with the factor of feeling the staff member did not know the patient or their family well enough. All three groups said they would be more likely to have a conversation about Do Not Attempt Resuscitation if barriers were addressed.

The efficacy of educational interventions on neonatal intensive care unit nurses knowledge and attitude toward neonatal palliative care

<b>Aim:</b> The objective of this study is examining the impact of an educational interventions in improving knowledge and attitudes towards neonatal palliative care (NPC)among nurses in Jordan.<br /> <b>Method: </b>A pre-post-test design was used to examine the efficacy of an educational program nurses’ knowledge and attitude toward NPC. Almost 164 nurses participated in the study, 82 intervention groups and 82 control groups.<br /> <b>Results: </b>The overall NPC mean knowledge score for the control group was 30.60 (SD=4.01) and for the intervention group was 73.85 (SD=5.78). The control group’s mean attitude for the NPC score is 88.94 (SD=14.45), whereas the intervention group’s is 82.13 (SD=10.59). There was also a substantial favorable effect of education program on nurses’ knowledge and attitude regarding NPC. Furthermore, there was no influence of characteristics on nurses’ knowledge and attitude regarding NPC.<br /> <b>Conclusion:</b> Depending on the findings of this study, the NPC educational program is beneficial in improving nurse knowledge and attitudes for NPC services, as well as providing an effective educational program for nurses. With the rising demand for NPC services with chronic critical illnesses and the documented good impact of NPC services on neonates in need and their families, it became imperative to improve the nurse’s knowledge and attitude toward NPC.

Current state of ethical challenges reported in Saudi Arabia: a systematic review & bibliometric analysis from 2010 to 2021

Background

Over the past few years, five domains of importance about the current state of bioethics in Saudi Arabia have shaped the perspective of most research: doctor-patient relationship, informed consent, do-not-resuscitate, organ donation, and transplantation, medical students’ knowledge and attitudes about medical ethics curriculum. This systematic review aimed to systematically identify, compile, describe and discuss ethical arguments and concepts in the best-studied domains of bioethics in Saudi Arabia and to present cultural, social, educational, and humane perspectives.

Methods

Six databases were searched using Boolean operators (PubMed, Embase, Web of Science, Scopus, CINAHL, Google Scholar) from December 2020–June 2021. The search and report process followed the statement and flowchart of preferred reporting items for systematic reviews and meta-analyses (PRISMA).

Resutls

The search resulted in 1651 articles, of which 82 studies were selected for a final review and assessment. There is a gradual increase in research, whereby a substantial increase was observed from 2017. Most of the published articles focused on ‘Organ Donation & Transplantation’ with 33 articles, followed by ‘Doctor-Patient Relations’ with 18 publications. Most of the published articles were from Central Province (33), followed by Western Province (16). The authorship pattern showed a collaborative approach among researchers. The thematic analysis of keywords analysis showed that ‘Saudi Arabia,’ ‘attitude PHC,’ ‘organ donation,’ ‘knowledge and education,’ and ‘donation’ have been used the most commonly.

Conclusion

This systematic quantitative synthesis is expected to guide researchers, stakeholders, and policymakers about the strengths and gaps in knowledge and attitudes regarding medical ethics in Saudi Arabia, both among the general public and health professionals.